Establishing your Client's diagnosis.

From the Client page you can navigate to the "Diagnosis & Treatment" tab.

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From this tab, you will be able to assign a diagnosis to your client by clicking on "Edit" in the Diagnosis section. A modal will appear where you have access to the complete DSM-5 diagnosis list, finding the right diagnosis description and ICD-10 codes is as simple as a quick search.

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Once you have selected the correct diagnosis, you can also add any additional notes you may have about the Client's diagnosis determination. Clicking "Save" will present you with another Modal where you will be required to sign the diagnosis change digitally. By typing your full name in this form, you acknowledge that you are providing your name to be used as an electronic representation of your signature and that all information entered is accurate and complete.

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Changes to the Client's diagnosis will be logged on the Client's summary page so you will have a record of every change made to the Client's diagnosis over time. You will also have the ability to change the Client’s diagnosis information from a session notes page (covered here).

Creating a Treatment Plan.

Click on "Add Treatment Plan" and you will be presented with a modal to create a Client's treatment plan.

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Our interface offers a standard approach to treatment plans; on the first screen, you will be required to enter the following fields:

  1. Presenting Problems - What problems led the Client to seek treatment. (You can add as many presenting problems as you need to)

  2. Behavior Definitions - How have the problems above been affecting your Client's day to day life. (You can add as many behavior definitions as you need to)

  3. Treatment Frequency - A recommendation for frequency of client sessions.

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    Screen 2:

    1. Goals - What are you and the Client attempting to accomplish through treatment. (You can add as many goals as you need to)
    2. Objectives - Approaches you will take with your Client to achieve their goals. (You can add as many objectives to a goal as you need to)
      1. Description - A specific skill or outcome you are trying to achieve.
      2. Interventions - The treatment modality you will be using to accomplish the Client objective.

    Once you have finished entering your Treatment Plan you need to activate it in order to start completing objectives. Clicking "Activate" will present you with another Modal where you will be required to sign the diagnosis change digitally. By typing your full name in this form, you acknowledge that you are providing your name to be used as an electronic representation of your signature and that all information entered is accurate and complete.

Once your Treatment Plan is active you can click the "..." menu to "Download" a PDF of the treatment plan for sharing with your Client or other interested party. From the same menu you can also "Archive" the treatment plan if it is no longer needed.

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The objectives in your treatment plan will be displayed as checkboxes; you can check them off as you complete them, and we will log the date. Once you are finished with a treatment plan, you can create a new one, and it will replace the complete treatment plan. We save every treatment plan on your patient record with the dates it was active.