SAMPLE INITIAL EVALUATION TEMPLATE
All treatment goals must be objective and measurable, with estimated time frames for completion. The treatment plan is to be developed with the patient, and the patient’s understanding of the treatment plan is to be documented in the medical record.
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OCA Official Form No.: 960 AUTHORIZATION FOR RELEASE OF ...
www.nycourts.govq Medical Record from (insert date) _____ to (insert date) _____ q Entire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology studies, films, referrals, consults, billing records, insurance records, and records sent to you by other health care providers.