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Psychiatric Diagnoses and Meds listing
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Client's Information
Client Name:
Client's DOB:
Client's ID #:
Client's Diagnosis
Diagnosis:
Diagnosis:
Diagnosis:
Harm to Self
Harm to Others
Socially Inappropriate
Other Target Behaviors
Hitting Self with open fist
Hitting Self with closed fist
Banging head on hard objects
Pinching self forcefully
Pulling own hair
Ingesting inedible objects
Select one category per case plan
Punching Others
Kicking others
Slapping others
Pulling others' hair
Biting others
Pinching others
Select one category per case plan
Throwing objects
Property destruction
Leaving assigned area without permission
AWOL
Select one category per case plan
Enter 1 target behavior per line.
Select one category per case plan
Issues Affecting Behavior
Insomnia
Physical pain
Trauma / PTSD
Other issues affecting Bx (Enter one per line):
ALERTS
Risk of choking
Dysphagia
Risk of falls
Other Alerts (Enter one per line):
