Master Treatment Plan - LMHA



ELEMENTS TO BE INCLUDED IN

Local Mental Health Authority Master Treatment Plan

Start Date: End Date:

Clinical Formulation Summary:

|Primary Diagnoses: | |Prioritized Problem List |

|Axis I | | |1 | |

|Axis II | | |2 | |

|Axis III | | |3 | |

|Axis IV | | |4 | |

|Axis V | | |5 | |

|# |Overall Goals |# |90-Day Objectives |Services to Address Goals and Objectives |

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Signed:

Name & Credentials:

Date of Signature:

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