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PCN-529-RS-T2CounselingTreatmentPlanTemplate.docx
PCN-529: Treatment Plan Template
Complete the treatment plan below. Be sure to include a description of the problem, goal statements, objectives, and interventions. Remember to incorporate the client's strengths and support system in the treatment plan.
*** Note: You are required to have a minimum of two overall goals, two objectives for each goal, and one intervention for each objective. If you have more than two overall goals, simply copy and paste the chart below.
Client: Click or tap here to enter text. Date: _______ Age: ________ DOB: ________
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ICD-9 (ICD-10) Code: |
Current DSM Diagnosis (Include Specifiers and Modifiers): |
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Description of the Problem: |
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Goal #1: |
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Objective(s): |
Intervention(s): |
Frequency: |
Target Date: |
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1. |
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☐ Weekly ☐ Bi-Weekly ☐ Monthly ☐ other: ____________________ Modality: ☐ Group ☐ Individual ☐Family |
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2. |
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☐ Weekly ☐ Bi-Weekly ☐ Monthly ☐ other: ____________________ Modality: ☐ Group ☐ Individual ☐Family |
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Description of the Problem: |
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Goal #2: |
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Objective(s): |
Intervention(s): |
Frequency: |
Target Date: |
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1. |
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☐ Weekly ☐ Bi-Weekly ☐ Monthly ☐ other: ____________________ Modality: ☐ Group ☐ Individual ☐Family |
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2. |
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☐ Weekly ☐ Bi-Weekly ☐ Monthly ☐ other: ____________________ Modality: ☐ Group ☐ Individual ☐Family |
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