ASI Treatment Plan Template
Client Name: Counselor Name:
Date
Problem Statement
Goals
D/C Criteria
Objectives
What will the client say or do? Under what circumstances? How often will he/she say or do this?
Interventions
What will the counselor/staff do to assist client? Under what circumstances?
Service Codes
Target Date
Resolution Date
Participation in Treatment Planning Process
Participation by Others in the Treatment Planning Process
Note: All participants may not have participated in every area.
Client Signature/Date
Counselor Signature/Date
Date
Problem Statement
Goals
D/C Criteria
Objectives
What will the client say or do? Under what circumstances? How often will he/she say or do this?
Interventions
What will the counselor/staff do to assist client? Under what circumstances?
Service Codes
Target Date
Resolution Date
Participation in Treatment Planning Process
Participation by Others in the Treatment Planning Process
Note: All participants may not have participated in every area.
Client Signature/Date
Counselor Signature/Date