PRELIMINARY TREATMENT PLAN Master Plan Internet		HUMBOLDT COUNTY HHS MENTAL HEALTH BRANCH / SEMPERVIRENS
PATIENT NAME Lohaloha D. Funohay	ADMIT DATE March 18, 2004			DATE / TIME OF PLAN March 18, 2004 04:28 hrs
PRELIMINARY DIAGNOSIS from admission orders: Enter Provisional Axis I Diagnosis
STRENGTHS ____________________ [MD]		Soh [RN]			____________________ [SW]
IDENTIFIABLE DISABILITIES Dl [RN]						____________________ [SW]
ELOS ____________________			PROGNOSIS ____________________

Problem / Reason for Hospitalization 1. Potential for Self-Harm AMB Furaha R/T Bulana
2. Medical Concerns: a. Dia
Long Term Goals [Discharge Objectives]
1. Very good Today 2. Dai od Tomorrow
Short Term Goals	Target Date	Date Met
1. Jama Now	Ja

Client signature: Date:

PRELIMINARY TREATMENT PLAN

PATIENT Lohaloha D. Funohay Admit Date: March 18, 2004

			[Name and Title]
	Special procedures for health and safety:
GOALS	Go		Marta Preusser RN
			Marta Preusser RN
	Medications:	Use this space to note any non-standard orders:	Jonathan Sommers MD Marta Preusser RN
	Haldol 2 PO QD
	Diet: Diet

PRELIMINARY TREATMENT PLAN

PATIENT Lohaloha D. Funohay Admit Date: March 18, 2004

			[Name and Title]
	Discharge and aftercare plans:		Name LCSW
JLKJ;LKJ;ALKJD;LAKJSD;KJ	Enter first intervention
	Plans for Continuing Care:		Name LCSW
GOALS	Enter first intervention
	Activities:		Name AT
GOALS	Enter first intervention
MD Signature: Date: Jonathan Sommers MD		Social Worker Signature: Date: Name LCSW
Nursing Signature: Date: Marta Preusser RN		Activity Worker Signature: Date: Name AT
		TREATMENT PLAN REVIEW: