Client Support Plan for
{{ client.fname }} {{ client.lname }}
(ID: {{ rec_id }})
Start Date:
{% if plan.end_date %} {{ plan.end_date }} {% else %} {# Leave it empty when the date is None #} {% endif %}
End Date:
Treatment Team:
Select Unit:
{{plan.unit_id}} -- {{ plan.unit_lname }}
{% for unit in units %}
{{unit.unit_id}} -- {{ unit.unit_lname }}
{% endfor %}
Case Manager:
Backup:
Supervisor:
Chart Number:
Admission Criteria:
Client is 18 years or older, has DSM5 diagnosis:
{{plan.diagnosis }}
Yes
No
Client demonstrates marked difficulties in self care:
{{plan.needs_selfcare }}
Yes
No
Client shows marked difficulties in maintaining social functioning:
{{plan.needs_skills}}
Yes
No
Client exhibits reliance on psychiatric treatment and support:
{{plan.needs_support}}
Yes
No
Client exhibits marked restriction of ADL:
{{plan.needs_adl }}
Yes
No
Client exibits deficiencies of concentration and task completion:
{{plan.needs_focus}}
Yes
No
Additional Information:
Rights and Grievance Procedures Reviewed With Client:
{{plan.rights_grievances or ''}}
Yes
No
Date:
Functional Assessment:
{% for funct in funct %}
Skill Area: {{funct.skill_area}}
Assessment: {{ funct.skill_level }}
{% endfor %}
Treatment Goals:
Goal 1 - Functional Assessment Skill Area:
{{plan.goal_one_header}}
{% for skill in sorted_skills %}
{{ skill.skill_area }}
{% endfor %}
Status:
{{plan.goal_one_status}}
{{plan.goal_one_status}}
2 - Active
1 - Attained
3 - Discontinued
Level:
{{plan.goal_one_level}}
Needs Attention
Needs Immediate Attention
Adequate
Excellent
Goal 1 - Client will:
{{ plan.goal_one_object }}
Goal 1 - Staff will:
{{ plan.goal_one_service }}
Goal 1 - Evaluation:
{{ plan.goal_one_eval }}
Goal 2 - Functional Assessment Skill Area:
{{plan.goal_two_header}}
{% for skill in sorted_skills %}
{{ skill.skill_area }}
{% endfor %}
Status:
{{plan.goal_two_status}}
{{plan.goal_two_status or ''}}
2 - Active
1 - Attained
3 - Discontinued
Level:
{{plan.goal_two_level or ''}}
Needs Attention
Needs Immediate Attention
Adequate
Excellent
Goal 2 - Client will:
{{ plan.goal_two_object }}
Goal 2 - Staff will:
{{ plan.goal_two_service }}
Goal 2 - Evaluation:
{{ plan.goal_two_eval }}
Goal 3 - Functional Assessment Skill Area:
{{plan.goal_three_header}}
{% for skill in sorted_skills %}
{{ skill.skill_area }}
{% endfor %}
Status:
{{plan.goal_three_status}}
{{plan.goal_three_status or ''}}
2 - Active
1 - Attained
3 - Discontinued
Level:
{{plan.goal_three_level or ''}}
Needs Attention
Needs Immediate Attention
Adequate
Excellent
Goal 3 - Client will:
{{ plan.goal_three_object }}
Goal 3 - Staff will:
{{ plan.goal_three_service }}
Goal 3 - Evaluation:
{{ plan.goal_three_eval }}
Goal 4 - Functional Assessment Skill Area:
{{plan.goal_four_header}}
{% for skill in sorted_skills %}
{{ skill.skill_area }}
{% endfor %}
Status:
{{plan.goal_four_status}}
{{plan.goal_four_status or ''}}
2 - Active
1 - Attained
3 - Discontinued
Level:
{{plan.goal_four_level or ''}}
Needs Attention
Needs Immediate Attention
Adequate
Excellent
Goal 4 - Client will:
{{ plan.goal_four_object }}
Goal 4 - Staff will:
{{ plan.goal_four_service }}
Goal 4 - Evaluation:
{{ plan.goal_four_eval }}
Submit
{% include '_footer.html' %}
}})