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Treatment Plan Template

Treatment Plan Template

Treatment Plan Template

Based on the information collected in week 4, complete the following treatment plan for your client Eliza. Be sure to include a description of the problem, goals, objectives, and interventions. Remember to incorporate the client’s strengths and support system in the treatment plan.

When completing a treatment plan with a client, be sure to include a diagnosis from the DSM V. This would include the diagnosis, specifiers, and code from the DSM. The ICD Code should also be included.

Include a minimum of two overall goals, at least two objectives for each goal, and at least one intervention for each objective. If you have more than two overall goals, simply copy and paste the chart below.

 

Client:

 

Date: Age: DOB:

 

 

ICD-10 Diagnosis (Code) DSM Diagnosis (Code and Description)

 

 

 

Description of the Problem:

 

Goal # 1:
Objective(s): Intervention(s): Frequency: Target Date:
1.   ☐ Weekly ☐ Bi-Weekly

☐ Monthly ☐ Other: ____________________

Modality:

☐ Group ☐ Individual

☐ Family

 
2.   ☐ Weekly ☐ Bi-Weekly

☐ Monthly ☐ Other: ____________________

Modality:

☐ Group ☐ Individual

☐ Family

 

 

 

 

Description of the Problem:
Goal # 2:
Objective(s): Intervention(s): Frequency: Target Date:
1.   ☐ Weekly ☐ Bi-Weekly

☐ Monthly ☐ Other: ____________________

Modality:

☐ Group ☐ Individual

☐ Family

 
2.   ☐ Weekly ☐ Bi-Weekly

☐ Monthly ☐ Other: ____________________

Modality:

☐ Group ☐ Individual

☐ Family

 

 

 

References:

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