SOP_NUMBER: 508.23-att-6
TITLE: Specialized Mental Health Treatment Unit Comprehensive Treatment Plan
WORD_COUNT: 158
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/338967
URL: https://gps.press/sop-data/508.23-att-6/
ATTACHMENTS:
1. Specialized Mental Health Treatment Unit Recommendation Form
URL: https://gps.press/sop-data/508.23-att-1/
2. Consent to Receive Specialized Mental Health Treatment
URL: https://gps.press/sop-data/508.23-att-2/
3. Specialized Mental Health Treatment Unit Admission Form
URL: https://gps.press/sop-data/508.23-att-3/
4. Activity Therapy Assessment – for Specialized Mental Health Treatment Program
URL: https://gps.press/sop-data/508.23-att-4/
5. Specialized Mental Health Treatment Unit (SMHTU) – Orientation to the Program
URL: https://gps.press/sop-data/508.23-att-5/
6. Specialized Mental Health Treatment Unit Comprehensive Treatment Plan
URL: https://gps.press/sop-data/508.23-att-6/
7. Specialized Mental Health Treatment Unit (SMHTU) Discharge Summary
URL: https://gps.press/sop-data/508.23-att-7/
8. Specialized Mental Health Treatment Unit Monthly Report (Monthly Utilization Review)
URL: https://gps.press/sop-data/508.23-att-8/
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FULL TEXT:
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SOP 508.23
Attachment 6
04/27/18
|Specialized
Mental Health
Treatment Unit
(SMHTU)
Comprehensive
Treatment Plan
(to be completed upon
admission and reviewed
weekly or bi-weekly by
the SMHTU counselor
and SMHTU treatment
team with the offender
present)|Offender Identification
Facility: ___________________________________
Name: ____________________________________
ID#: __________________DOB: ______________
Race: ____________ Sex: __________________|Col3|Col4|
|---|---|---|---|
|Admission Diagnosis:|Admission Diagnosis:|Admission Diagnosis:||
|Problem #______
|Problem #______
|Problem #______
||
|Goal:
Target
Date:|Goal:
Target
Date:|Goal:
Target
Date:||
|Interventions:
|Interventions:
|Person Responsible:
______________________
______________________
(Title)
Enter Date: _____________
Revised/Resolved: _______
Date: __________________||
|Problem #_______
|Problem #_______
|Problem #_______
||
|Goal:
Target Date:|Goal:
Target Date:|Goal:
Target Date:|
|
|Interventions:
|Interventions:
|Person Responsible:
______________________
______________________
(Title)
Enter Date: _____________
Revised/Resolved: _______
Date: __________________||
|
Mental Health Counselor: ______________________________________
___________________________________ __________________
Offender Signature Date Signature Date|
Mental Health Counselor: ______________________________________
___________________________________ __________________
Offender Signature Date Signature Date|
Mental Health Counselor: ______________________________________
___________________________________ __________________
Offender Signature Date Signature Date||
Retention Schedule: Upon completion, this form shall be placed in the offender’s mental health file (section 1). At the end of the offender’s need
for mental health services and/or sentence, the mental health file shall be placed within the offender’s health record and retained for ten (10)
years.