Goal-directed & logical Tangential Thought Process Loose associations (observed/inquired) Disorganized Other: Homicidal ideation Delusions Suicidal ideation None Passive Obsessions/compulsions NonePassive Active Active Phobias Thought Content If active: (observed/inquired) Plan: Yes No If active: Intent: Yes No Plan: Yes No Means: Yes No Intent: Yes No Means: Yes No No hallucinations or Oriented x3 Perception delusions evident during Orientation Other: (observed/inquired) interview (inquired) Other: Short-term intact Long-term intact Good Memory/Concentration Insight/Judgment Distractible/Inattentive Fair (observed/inquired) (observed/inquired) Immediate memory Poor Other: Additional Comments on Goal Planning Process (add relevant consumer comments and/or practitioner impressions): SECTION 2: Transitioning the PRNA/CRNA to the Preliminary Individualized Rehabilitation Plan (PIRP)/Individualized Rehabilitation Plan (IRP) Review information obtained in SECTION 1 – PARTS A AND B. Then list ALL goals gathered from KEY LIFE DOMAINS below:
Thought Process (observed/inquired) Goal-directed & logical Tangential Loose associations Disorganized Other: Thought Content (observed/inquired) Suicidal ideation NonePassive Active If active: Plan: Yes No Intent: Yes No Means: Yes No Homicidal ideation None Passive Active If active: Plan: Yes No Intent: Yes No Means: Yes No Delusions Obsessions/compulsions Phobias Perception (observed/inquired) No hallucinations or delusions evident during interview Other: Orientation (inquired) Oriented x3 Other: Memory/Concentration (observed/inquired) Short-term intact Long-term intact Distractible/Inattentive Immediate memory Other: Insight/Judgment (observed/inquired) Good Fair Poor Additional Comments on Goal Planning Process (add relevant consumer comments and/or practitioner impressions): SECTION 2: Transitioning the PRNA/CRNA to the Preliminary Individualized Rehabilitation Plan (PIRP)/Individualized Rehabilitation Plan (IRP) Review information obtained in SECTION 1 – PARTS A AND B. Then list ALL goals gathered from KEY LIFE DOMAINS below:
PRNAandCRNATemplate.docx