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=""]
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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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