Treatment Plan with fillable goals

ASSESSMENT
[checkbox name="prognosis" value="" memo="Prognosis statement"][conditional field="prognosis" condition="(prognosis).is('')"]Patient is currently displaying [select value="symptoms of|well managed|moderately managed|poorly managed"] [checkbox value="depression|anxiety|sleep disturbance|psychosis|substance abuse|cognitive impairment|impulsivity|mood lability|alcohol dependence|opiate dependence|autism spectrum disorder"][textarea memo="other" default="" rows="1"] [select value="likely caused by|likely exacerbated by|likely the result of"] [checkbox value="their cancer diagnosis|their cancer treatment|their unmanaged depressive disorder|their unmanaged anxiety disorder|their unmanaged bipolar disorder|interpersonal/family conflict|current psychopharmaceutical intervention|current psychotherapy|current psychosocial support systems"][textarea memo="other" default="" rows="1"]. Patient would benefit from [checkbox value="initiation of psychopharmaceutical intervention|continued psychopharmaceutical intervention|adjustments to current psychopharmaceutical intervention|initiation of psychotherapy|continuation of current psychotherapy|engaging in grief therapy|engaging in CBT|engaging in family therapy|enhanced psychosocial supports|increasing personal time and self-care"]. [/conditional][conditional field="prognosis" condition="(prognosis).is('')"]Prognosis is [select value="good|fair|poor"] considering the patient [select value="remains adherent to|actively engages in|is not currently responding to|is not currently willing to engage in recommended|has chronically had poor response to"] medication/therapy to address [textarea memo="target of treatment" rows="1"][checkbox value=" and whether they are able to engage constructively with social supports"]. [checkbox name="barrier" value="Barriers to success include: "][/conditional][conditional field="barrier" condition="(barrier).is('Barriers to success include: ')"][checkbox value="current apprehension to engage in psychopharmaceutical intervention|current apprehension to engage in structured psychotherapy|current emotional distress of recent cancer diagnosis|limited social supports|dysfunctional interpersonal relationships"][textarea memo="barriers" rows="1"].[/conditional] [conditional field="prognosis" condition="(prognosis).is('')"][checkbox name="strength" value="Patient strength for success include: "][/conditional][conditional field="strength" condition="(strength).is('Patient strength for success include: ')"][checkbox value="expression of willingness to engage in treatment recommendations|positive social supports|are well connected with outpatient supports|history of actively engaging in mental-health treatment"][textarea memo="strengths" rows="1"].[/conditional] [textarea rows="5"]

GOALS

[checkbox name="Depression" value="-Patient will report score on PHQ-9 of "][conditional field="Depression" condition="(Depression).is('-Patient will report score on PHQ-9 of ')"][select value="8|5|6|7|8|9|10|11|12|13|14|15"] or less within [select value="3 months|1 month|2 months|3 months|4 months|5 months|6 months"]: Initiated [date default="today"][checkbox value=" not currently meeting| currently meeting|worsening|improving|stable"][/conditional][textarea rows="1"][checkbox name="Anxiety" value="
-Patient will report score on GAD-7 of "] [conditional field="Anxiety" condition="(Anxiety).is('
-Patient will report score on GAD-7 of ')"][select value="8|5|6|7|8|9|10|11|12|13|14|15"] or less within [select value="3 months|1 month|2 months|3 months|4 months|5 months|6 months"]: Initiated [date default="today"][checkbox value=" not currently meeting| currently meeting|worsening|improving|stable"][/conditional][textarea rows="1"][checkbox name="Substances" value="
-Patient will reduce substance intake by 50% within "][conditional field="Substances" condition="(Substances).is('
-Patient will reduce substance intake by 50% within ')"][select value="1 month|2 months|3 months|4 months|5 months|6 months"]: Initiated [date default="today"][checkbox value=" not currently meeting| currently meeting|worsening|improving|stable"][/conditional][textarea rows="1"][checkbox name="Sleep" value="
-Patient will experience 6+ hours of uninterrupted sleep per night within "][conditional field="Sleep" condition="(Sleep).is('
-Patient will experience 6+ hours of uninterrupted sleep per night within ')"][select value="3 months|1 month|2 months|3 months|4 months|5 months|6 months"]: Initiated [date default="today"][checkbox value=" not currently meeting| currently meeting|worsening|improving|stable"][/conditional][textarea rows="1"][checkbox name="Cognition" value="
-Patient will report impact of cognitive impairment as mild/resolved within "][conditional field="Cognition" condition="(Cognition).is('
-Patient will report impact of cognitive impairment as mild/resolved within ')"][select default="3" value="3 months|1 month|2 months|3 months|4 months|5 months|6 months"]: Initiated [date default="today"][checkbox value=" not currently meeting| currently meeting|worsening|improving|stable"][/conditional][textarea rows="1"]


PLAN:
[textarea rows="5"]
ASSESSMENT
Prognosis statement

GOALS




PLAN:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.74, 57 form elements, 3 boilerplate words, 12 text areas, 5 dates, 19 checkboxes, 11 drop downs, 10 conditionals, 101 total clicks
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