Employment/ Volunteer Education Meaningful Activities Activities Financial/Benefits Other: (include SSA, VA benefits) Current Needs Selected Above as Evidenced By: Addictive Behavior and Substance Use CN = Current Need Area CN PFD CN PFD PFD = Person/Family Desires Change Now Substance Use/ Other Addictive Behaviors Addiction (food, gambling, exercise, sex etc.) (Tobacco, illicit & licit drugs) Current Selected Above as Evidenced By: Mental Health/ Illness Management-Behavior Management CN = Current Need Area CN PFD CN PFD CN PFD PFD = Person/Family Desires Change Now Attachment Conduct Hyperactivity Atypical Behaviors Depression/Sadness Impulsivity Attention Dissociation Disturbed Reality Anxiety Swings (Hallucinations) Disturbed Reality Obsessions (Delusions) Antisocial Behaviors Emotional Control Oppositional/ Coping/Symptom Eating Disturbance Somatic Problems Management Skills Cognitive Delay Gender Identity Stress Management Person’s Name (First MI Last): Record #: Compulsive Behavior Grief/Bereavement Trauma Other: Current Needs Selected Above as Evidenced By: Physical Health CN = Current Need Area PFD = Person/Family Desires CN PFD CN PFD CN PFD Change Now
Education Employment/ Volunteer Activities Meaningful Activities Financial/Benefits (include SSA, VA benefits) Other: Current Needs Selected Above as Evidenced By: Addictive Behavior and Substance Use CN = Current Need Area PFD = Person/Family Desires Change Now CN PFD CN PFD Substance Use/ Addiction (Tobacco, illicit & licit drugs) Other Addictive Behaviors (food, gambling, exercise, sex etc.) Current Selected Above as Evidenced By: Mental Health/ Illness Management-Behavior Management CN = Current Need Area PFD = Person/Family Desires Change Now CN PFD CN PFD CN PFD Attachment Conduct Hyperactivity Atypical Behaviors Depression/Sadness Impulsivity Attention Dissociation Anxiety Disturbed Reality (Hallucinations) Swings Disturbed Reality (Delusions) Obsessions Antisocial Behaviors Emotional Control Oppositional/ Coping/Symptom Management Skills Eating Disturbance Somatic Problems Cognitive Delay Gender Identity Stress Management Person’s Name (First MI Last): Record #: Compulsive Behavior Grief/Bereavement Trauma Other: Current Needs Selected Above as Evidenced By: Physical Health CN = Current Need Area PFD = Person/Family Desires Change Now CN PFD CN PFD CN PFD