Continuing Care Plan Template

[text name="variable_1" default="Insert Patient Name "] has the current diagnosis of:
[text name="variable_1" default="Insert Patient Name "] is reccomended to follow up with [checkbox name="variable_1" value="Mental health therapy| Psychiatric services| SUD| Mat| Family Therapy| Case management | medical care| other"] to manage their emotional and behavioral needs.


[text name="variable_1" default="Insert Patient Name "] reports their current legal status is: [textarea name="variable_15" default="sample text"]


[text name="variable_1" default="Insert Patient Name "] identifies current employment as [checkbox name="variable_2" value="fulltime | part time| Self employed| Un employed| retired| stay at home| No concerns regarding employment | concerns with employment"] and would benefit from ongoing support via family and sober friends to maintain sobriety to increase employment / opportunity for employment or ongoing engagement in daily activities.


[text name="variable_1" default="Insert Patient Name "] reports their financial concerns are:


[textarea name="variable_1" default="sample text"]. Current insurance provider is: [textarea name="variable_2" default="sample text"] and identifies [select name="variable_1" value="concerns | No concerns"]


[text name="variable_1" default="Insert Patient Name "] current housing situation is: [checkbox name="variable_10" value="recovery housing| return to previous living environment| Living with sober support| ongoing care| other"]

Staff explored with [text name="variable_1" default="Insert Patient Name "] benefits of alternative housing, sober living, recovery housing, treatment with boarding etc. [text name="variable_1" default="Insert Patient Name "] reports no concerns with current reported plan for housing as indicated above

[text name="variable_1" default="Insert Patient Name "] identifies [select name="variable_10" value="concerns | no concerns"] with current transportation.

[text name="variable_1" default="Insert Patient Name "] reports support network includes: [checkbox name="variable_15" value=" family | sober supports| 12 step meetings| Church or other community| Sponsor | Desire to connect with meetings or sponsor | PHP| IOP| OPT| residential| other care"] for ongoing support Staff provided [text name="variable_1" default="Insert Patient Name "] with psychoeducation regarding MAT services.

[text name="variable_1" default="Insert Patient Name "] reports the would like to explore: [checkbox name="variable_19" value="naltrexone | Suboxone| Vivitrol| Sublocade | Antabuse| More psychoeducation| Discussing more with Outpatient services| Follow up with Mat provider outside of RCA| Follow up with psychiatrist | Follow up with PCP| Declined services"]

[text name="variable_1" default="Insert Patient Name "] current mental health dx are:
[text name="variable_1" default="Insert Patient Name "] reccomended ongoing level of care are: [checkbox name="variable_100" value="IOP | PHP | Residential| MAT | Psychiatric support| Family therapy| Mental health therapy| PCP follow up | Substance abuse tx"] and [text name="variable_1" default="Insert Patient Name "] decided on [checkbox name="variable_101" value="IOP | PHP | Residential| MAT | Psychiatric support| Family therapy| Mental health therapy| PCP follow up | Substance abuse tx"]


[text name="variable_1" default="Insert Patient Name "] reports their current PCP provider status is: [select name="variable_109" value= "Has relatioship with provider | Declines having provider"]
[checkbox name="variable_112" value=" They have declined to sign ROI for this provider, psychoeducation was provided regarding benefits of roi and collaboration of care.| Declined to set appointment with staff for follow up, psychoeducation regarding follow up appointment was provided and they have been urged to follow up ASAP| Has roi on file for provider, but declined to schedule with staff. Discussion and psychoeducation of benefits of scheduling has been explored and they are encouraged to follow up asap| Agreeable to setting appointments"]


[text name="variable_1" default="Insert Patient Name "] identifies healthy leisure activities such as:  [textarea name="variable_800" default="sample text"]