Mental Health Care Plan Template printable pdf download

Mental Health Care Plan Template

Care Plan for _____________________________________Chart Reviewed___ Date _________________

Birth Date __________________ Age ________ Parent/Guardian _________________________________

DSM IV Diagnosis: Axis 1: _________________________________________________________________

Axis 2: _________________________________________________________ (optional)

Axis 3: _________________________________________________________ (optional)

Axis 4: _________________________________________________________ (optional)

Axis 5: _________________________________________________________ (optional)

Participants in creation of Plan: ____________________________________________________________

Medications:_____________________________________________________________________________

________________________________________________________________________________________

Current concerns or problems: _____________________________________________________________

________________________________________________________________________________________

Risk Screening Tool Results: ______________________________________________________________

________________________________________________________________________________________

Current supports and strengths: ____________________________________________________________

________________________________________________________________________________________

Summary of Condition: ___________________________________________________________________

________________________________________________________________________________________

Activity Plan (goals, sleep, meals, activity, screen time, school attendance, resources recommended):

________________________________________________________________________________________

Plan: ___________________________________________________________________________________

________________________________________________________________________________________

Risk Screening: _____________________________________________________________________

Communication with the following health professionals is approved by client:

________________________________________________________________________________________

What to do if things don’t improve: __________________________________________________________

________________________________________________________________________________________

Reassessment will be in ___________________________________________________________________

Mental Health Care Plan Template