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Patient Care Plan

Patient: ________________________________________________________ PCP: ______________________________________________

Medical Diagnosis: ___________________________________________________________ Sex: ______________ Date: _______________

ASSESSMENT- DOMAINS

Subjective Data Objective Data

Patient Problem Statement(s):

Patient Goal Statement(s):

Depression Screening (Interventions if applicable) Medication Reconciliation (Interventions if applicable)

Leadership is the art of getting someone else to do something you want done because he wants to do it. | Dwight Eisenhower