Concurrent Report and Treatment Plan
Document the client's current status and outline the proposed treatment plan. Please complete all relevant sections accurately.
Client Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of Report
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Referring Professional or Agency
Diagnosis or Presenting Problem
*
Assessment Findings / Observations
*
Treatment Goals (select all that apply)
*
Symptom reduction
Skill development
Improved daily functioning
Increased social support
Other
Planned Interventions (select all that apply)
*
Individual therapy
Group therapy
Medication management
Family involvement
Community resources referral
Other
Progress Since Last Report
Collaboration/Consultation with Other Professionals
Next Steps / Follow-Up Plan
*
Signature of Person Completing Report/Treatment Plan
*
Submit Report and Treatment Plan
Submit Report and Treatment Plan
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