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