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DISCHARGE SUMMARY TRANSITION SUMMARY
CONSUMER NAME:
Admission Date: Last Service Date: Discharge Date:
PRESENTING PROBLEM:
LIVING ARRANGEMENT AT LAST CONTACT:
Medications upon discharge
SERVICES PROVIDED
Diagnostic Evaluation Early Intervention Counseling/Training- Individual Parent Training
Psychiatric Assessment Brief Stabilization Counseling/Training-Group Parent Aide
Nursing Assessment Intensive Family Intervention Counseling/Training-Family Other (List):
Medication Management Community Support Individual Behavioral Aide Other (List):
DIAGNOSTIC STATUS UPON DISCHARGE
AXIS I
PROGRESS MADE TOWARD DISCHARGE/TRANSITION
Reason Discharged
Strengths
Needs
Abilities
Preferences
RECOMMENDATIONS FOR SERVICES OR SUPPORT/TRANSITION TO
JCCS Staff Signature, Credentials Date JCCS Staff Printed Name, Credentials
Was the consumer offered a copy of this Plan? Yes No — If no, why not?
POST DISCHARGE FOLLOW UP
How is client doing? Much Improved Somewhat Improved Unchanged Worse F/U contact unsuccessful
Comments
Client’s report of effectiveness
of post transition services
Additional services needed? Yes No If yes, plan to meet the need:
BH16.01(b)-Transition or Discharge Summary Jireh Counseling and Consulting Service, Inc. RevOCT2008