TREATMENT PLAN REVIEW

Client: [Name or ID]
Review date: [Date]
Review period: [Which review this is, and the weeks or days it covers]
Plan under review: [Date of the current plan, and of the last review]
Diagnosis: [Current diagnosis, and any change since the plan was written]
Sessions this period: [Attended, cancelled, and missed; format and length]
Reviewed by: [Clinician name, credentials; supervisor, psychiatrist, or others who took part]
Client took part: [In session, by video, or how else the client was involved]

MEASURES OVER TIME
Measure 1: [Name; baseline score and date; each score since; today's score]
Measure 2: [Name; baseline score and date; each score since; today's score]
Individual targets: [What the client counts, such as days attended, panic attacks, nightmares, or shifts worked, then and now]
Reading the scores: [Response, remission, no reliable change, or worse, set against the targets in the plan]

GOAL REVIEW
Goal 1: [The goal as the plan states it]
Objective and target: [The objective, its measure, and the date it was due]
Where it stands: [Today's numbers beside the target]
What helped: [Techniques, skills, or changes the client credits]
Barriers: [Attendance, symptoms, life events, substance use, or a poor fit of approach]
Decision: [Continue, change, achieved, or discontinued, with the reason and any new target]

Goal 2: [The goal as the plan states it]
Objective and target: [The objective, its measure, and the date it was due]
Where it stands: [Today's numbers beside the target]
What helped: [Techniques, skills, or changes the client credits]
Barriers: [Attendance, symptoms, life events, substance use, or a poor fit of approach]
Decision: [Continue, change, achieved, or discontinued, with the reason and any new target]

New problems: [Anything that has come up since the plan, with a goal and measurable objective, or none]

CHANGES TO CARE
Frequency and length: [Before this review and from now on]
Approach: [Unchanged, a new technique, or a different evidence-based therapy, and why]
Level of care: [Stay, step up, or step down, and the reason]
Medication and referrals: [Psychiatry, primary care, group, or other services, with the client's consent]
Risk: [Today's screen, and whether the safety plan was reviewed or changed]

CLIENT'S VIEW
Progress in the client's words: [What the client says has changed]
Scores and experience: [Where the client's view and the scores agree or differ]
Next priorities: [What the client wants to work on now]
Agreement: [The client's view of each decision, and anything they changed]

NEXT REVIEW
Discharge or step-down criteria: [Unchanged, or revised at this review]
Next review: [Date, and the score change that would bring it forward]
Client signature: [Signature and date, or how the client agreed]

Signed: [Clinician name, credentials, date and time]