Personal Physician Care Plan

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Are you looking for a professional Personal Physician Care Plan? If you've been feeling stuck or lack motivation, download this template now!

Do you have an idea of what you want to draft, but you cannot find the exact words yet to write it down or lack the inspiration how to make it? If you've been feeling stuck, this Personal Physician Care Plan template can help you find inspiration and motivation. This Personal Physician Care Plan covers the most important topics that you are looking for and will help you to structure and communicate in a professional manner with those involved. 

ADULT CARE HOME PERSONAL CARE PHYSICIAN AUTHORIZATION AND CARE PLAN Assessment Date // Reassessment Date // Significant Change// RESIDENT INFORMATION (Please Print or Type) RESIDENT SEX (M/F) DOB // MEDICAID ID NO.. Frequency Route ( ) If Self-Administered MENTAL HEALTH AND SOCIAL HISTORY: (If checked, explain in “Social/Mental Health History” section) Wandering Verbally Abusive Physically Abusive Resists care Suicidal Homicidal Disruptive Behavior/ Socially Inappropriate Injurious to: Self Others Property Is the resident currently receiving medication(s) for mental illness/behavior YES NO Is there a history of: Substance Abuse Developmental Disabilities (DD) Mental Illness Is the resident currently receiving Mental Health, DD, or YES NO Substance Abuse Services (SAS) Has a referral been made YES NO If YES: Date of Referral Name of Contact Person Agency Social/Mental Health History:

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