WPC3  z᎝ZW|Z&< ?oR.Z,tyP^作 Xi"("vޤW(ԮQT˅*P/7ҮL;̜he^4\GL{ÎEWW"@"\+P_ *'5;(@}LON$ڬ:& |VtvZ%b ZposZg0 E)x$afag8˲R^Tƒ}T "\%ChL'Gwݼ!+09mKHNB'>d eʓ/Y[ܴ%5[Go%;D9>J߿ѡJڱCwܝ+o{ tjRsUng,C;6DqH?{ب89-#C?Zx/N]횓gzoКnD6|x \UB&nXh % 0( 0f8#(g N ^ w 4  m U0 U2 e0 0 N1 \  `*Times New RomanTT\  `*Times New RomanTTC\  P6QP\  `*Times New RomanTTXXP\  P6QXP'    2 $Deborah Blais$0Michael Cohen .   h:Default ParaDefault Paragraph Font        3|x (>^W$xXZ XxHP Color LaserJet 2600n0!y95 m80BackupU) p`CG Times(@ ZCG Times  ^W!PXZXP  _@@@# MONITORREPORT   @ll%(Clinical) x Reportcoversperiodof:򀀀 X NameofParticipant:򀀀  Numberofinformalcontacts(telephoneetc.)withtheparticipantduringthisperiod:򀀀 ( x Numberoffacetofacepsychotherapysessions:򀀀    ArethereanychangesinAxisIthroughVdiagnosesduringthisperiod? H   Yes[]No[]Unknown[]0  Ifso,pleaseexplainindetailonthereverseside.` (#(# Istheparticipantmakingprogressintermsofbehavioral,measurabletreatmentgoals?   Yes[]No[]Unknown[]0  0h(#(#Ifnot,pleaseexplainonthereverseside.h h(#h(# Hastheparticipantattendedhis/herscheduledappointmentsduringthisperiod? H  Yes[]No[]Unknown[]0  Ifnot,pleaseexplainonthereverseside.(#(# Istheparticipantdemonstratinganattitudeofcooperationatthistime? P Yes[]No[]Unknown[]0  Pleaseexplainanyproblemsonthereverseside.h(#(# Hastheparticipantsignedthetreatmentplandemonstratinganunderstandingofthegoals?  Yes[]No[]NotApplicable[] p Istheparticipantcapableofpracticinglawatthistime? P Yes[]No[]0 0 (# (#0h(#(#Ifnot,pleaseexplainindetailonthereverseh(#h(#    `    `     h   򀀀__Ԁ 8    `     h   MonitorsInitials     x! XZXXXZ&%XXZ Pleasecommentonanyinstancesofnoncompliancenotedonthepreviouspage,onthe h participant'soverallparticipationinhis/hertreatment(medication,family,professionalissues),  p andprovideanyrecommendationsyoumayhaveastohowFLAcanassistyouortheparticipant ( inanyway.Thankyou.   ____________________________________________________________________________________  P ____________________________________________________________________________________ p  ____________________________________________________________________________________  0  ____________________________________________________________________________________ P   ____________________________________________________________________________________   ____________________________________________________________________________________ 0     `     h 򀀀 `    `     h Monitor     `     h 򀀀 8    `     h Date @ Revised11/6/01 h .@0F:\Forms\Monrpt Clin.wpd@F:\Forms\MonrptClin.wpd/  #&%%&##XZX%&#