To submit your filled-out treatment plan, email it to the designated mental health provider at the provided email address. Alternatively, you may fax the document to the listed fax number. For physical submissions, send the completed form to the office address provided within the document, ensuring it reaches the office by the due date.

Key dates relevant to this treatment plan include the establishment of treatment goals, ongoing assessments, and overall project deadlines. Critical completion dates range from the initial assessment to quarterly reviews. Ensure to note these dates for accurate monitoring and compliance.

The purpose of this document is to outline a structured approach for developing a treatment plan in mental health contexts. It serves as a guide for setting objectives, documenting interventions, and tracking patient progress. This standardized format ensures clear communication among healthcare providers and patients while addressing specific mental health issues.

• 1. Recipient Information: Holds details about the patient such as name, Medicaid number, and date of birth.
• 2. Provider Information: Includes the professional's name, Medicaid number, and treatment plan dates.
• 3. Treatment Goals: Outlines both long-term and short-term goals intended for patient progress.
• 4. Medication Details: Specifies any medications prescribed, including dosage and frequency.
• 5. Intervention/Action: Lists the interventions or actions to be taken by healthcare providers.

Failing to submit this form may result in insufficient documentation of a patient's treatment plan. This could hinder progress tracking and appropriate intervention strategies. Incomplete submissions might delay necessary care and communication within treatment teams.

• Incomplete Documentation: Lack of detailed information may prevent accurate treatment planning.
• Delayed Care: Without timely submission, patient care may be put on hold.
• Miscommunication: Issues can arise from unclear or missing information in the treatment plan.

• 1. Initial Assessments: Utilize this form to formally document the first treatment plan for a patient.
• 2. Ongoing Care Updates: Reassess and adjust goals and interventions as needed during ongoing treatment.
• 3. Periodic Reviews: Use this form to evaluate patient progress and modify treatment strategies.