Treatment Plan
Client Name: Counselor Name:
|Date |Problem Statement |
| | |
| | |
| | |
|Goals |
| |
| |
| |
|D/C Criteria |Objectives |
| |What will the client say or do? Under what circumstances? How often will he/she say or do this? |
| | |
| | |
| | |
|Interventions |Service |Target Date |Resolution Date|
|What will the counselor/staff do to assist client? Under what circumstances? |Codes | | |
| | | | |
| | | | |
| | | | |
|Participation in Treatment Planning Process |
| |
| |
|Participation by Others in the Treatment Planning Process |
| |
| |
| |
Note: All participants may not have participated in every area.
|Client Signature/Date |
|Counselor Signature/Date |
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