ABHS Discharge Rpt updt
[select name="refSrc" value="Adult Probation|Family Criminal Court|The Bail Commission|Other"] referred [text name="cxName" default=""] to CRJ Behavioral Health Program for an integrated mental health and substance use evaluation due to a charges of [textarea name="cxChrgs" default=""]. The client completed [select name="pro1" value="her|his|their"] intake assessment on [date name="intkDt" default=""]. The initial diagnosis was [textarea name="intlDx" default=""]. Further biopsychosocial factors included [checkbox name="othBioPsySoc" value="problems related to primary supports|problems related to social supports|educational problems|unemployment|under employment|homelessness|being under housed|negative life events in childhood|experience with traumatic events|problems related to health services|victim of intimate partner violence|other family/relationship conflict|other family/relationship violence"]. During treatment the client’s substance test results were [select name="urinPosNeg" value="positive for|negative for all substances|"] [textarea name="urinRslt" default=""]. The initial treatment [select name="gram1" value="recommendation was|recommendations were"] [textarea name="intlRec" default=""]. Client [select name="psyEvl" value="completed|did not complete|was not referred for|missed all appointments for"] a psychiatric evaluation [conditional field="psyEvl" condition="(psyEvl).is('completed')"]on [date name="psyEvalDt" default=""] in which the [select name="gram2" value="recommendation was|recommendations were"][/conditional] [textarea name="psychRec" default=""]. [var name="cxName"]'s identified [select name="gram3" value="goal was|goals were"] [textarea name="cxGoals" default=""]. Client agreed to work on [textarea name="txProcess" default=""]. Client’s response to the treatment was [textarea name="cxResp" default=""]. The main obstacles to treatment included [textarea name="txObstcls" default=""]. Other areas of concern addressed during the treatment were [textarea name="othCnc" default=""]. Of the [text name="numSess" default="" size="5"] total sessions client was scheduled to attend the client attended [text name="missSess" default="" size="5"]. [comment memo="Client's explanation for missed appts"] [select name="cxExplain" value="Client’s explanation for missed appointments was|Client gave no explanation for missed appointments"] [textarea name="explMiss" default=""]. During the treatment period the client was [select name="variable_1" value="also engaged in services with|not engaged in any other services"] [textarea name="othSvrPrv" default=""]. Client was discharged from the program due to [textarea name="dhxReas" default=""]. At termination the diagnosis [textarea name="dchxDx" default="remained the same"]. Discharge recommendations are [textarea name="dchxRecc" default="to continue psychotherapy and psychiatric care in the community/with a private practitioner"].
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Sandbox Metrics: Structured Data Index 0.4, 33 form elements, 113 boilerplate words, 3 text boxes, 15 text areas, 2 dates, 1 checkboxes, 9 drop downs, 1 variables, 1 comments, 1 conditionals, 42 total clicks
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