DISCHARGE SUMMARY
PATIENT NAME: _____________DIAGNOSIS: __________________DATE: _____________
REASONS FOR DISCHARGE: ___________________________________________________
INTERVENTIONS USED
EXPRESSIVE THERAPY GOALS
1. _______________________
1. ___________________________
2. _______________________
2. ___________________________
3. _______________________
3. ___________________________
4. _______________________
4. ____________________________
PROGRESS ACHIEVED: ________________________________________________________
FUTURE GOALS:
LEISURE BARRIERS:
1. ______________________________
1. ____________________________
2. ______________________________
2. ____________________________
3. ______________________________
3. ____________________________
4. ______________________________
4. ____________________________
--------------------------------------------------------------------------------------------------------------------To Be Filled Out By The Expressive Therapist
DISCHARGE RECOMMENDATIONS: ____________________________________________
--------------------------------------------------------------------------------------------------------------------PATIENT SIGNATURE: ___________________
EXPRESSIVE THERAPIST SIGNATURE: ______________
DATE: ____________