CSSD Progress Report

Client Name: [text name="cxName" default=""]
Date of Report: [date name="reportDate" default=""]
[comment memo="Diagnosis/Prognosis:"]
[var name="cxName"]'s diagnoses are [textarea name="dxPrx" default=""]
[comment memo="Treatment Recommendations and/or changes to recommendation:"]
The current treatment recommendations are to [checkbox name="recommendations" value="complete psychiatric evaluation|additional assessment needed|anger management group|co-occurring group|participate in individual counseling|intensive out patient|medically assisted treatment|med management|mental health group|no treatment recommendations|other services outside of program|relapse prevention group|substance abuse group|trauma group"]
[textarea name="txRec" default=""]
[comment memo="Client progress, participation, and benefits from and/or refusal to cooperate in services:"]
[textarea name="cxProg" default=""]
[comment memo="Other Services client is known to be receiving:"]
[textarea name="otherServices" default=""]
[comment memo="Client’s explanation of missed groups/sessions:"]
[textarea name="missed" default=""]
[comment memo="Issues or concerns with substance abuse testing:"]
[textarea name="testing" default=""]
[comment memo="Employment Activity:"]
[textarea name="employment" default=""]
[comment memo="Other pro-social involvement:"]
[textarea name="otherPro" default=""]
[comment memo="Miscellaneous but important and related information:"]
[textarea name="misc" default=""]
[comment memo="Important details not entered into CDCS:"]
[textarea name="impDetails" default=""]
[var name="cxName"]'s psychiatric evaluation is scheduled for [date name="psyEval" default=""]
[comment memo="Results of psychiatric evaluation:"]
[textarea name="psyEvalRslt" default=""]
Client Name:
Date of Report:
Diagnosis/Prognosis:
cxName's diagnoses are
Treatment Recommendations and/or changes to recommendation:
The current treatment recommendations are to

Client progress, participation, and benefits from and/or refusal to cooperate in services:

Other Services client is known to be receiving:

Client’s explanation of missed groups/sessions:

Issues or concerns with substance abuse testing:

Employment Activity:

Other pro-social involvement:

Miscellaneous but important and related information:

Important details not entered into CDCS:

cxName's psychiatric evaluation is scheduled for
Results of psychiatric evaluation:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.2, 28 form elements, 20 boilerplate words, 1 text boxes, 11 text areas, 2 dates, 1 checkboxes, 2 variables, 11 comments, 28 total clicks
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