Letter To The Patient Non-Compliance

3. The patient had informed this writer initially of his goals of wanting to return back to the Hartford Dispensary due to the length of time he has been with the clinic and his positive rapport with his prior counselor at the other facility. The patient was compliant with his individual sessions with this writer and provided cancellation if unable to attend the session in the meantime while he awaits on the process of completion with his intake at Hartford Dispensary.

D-The patient arrived on time for her session. Reports stable on her dose. This writer discussed about tapering off on her methadone, at which the patient is willing to consider doing, but needs more time. She then says, " I might consider doing it next month, but not right now......I was doing it before, but it stopped....just want to take my time." The patient then discussed about having to go to SSA to obtain the payment for the funeral cost. The patient is upset about the small amount she is about to receive. This writer discussed the grieving process of her loss of her husband and also, her mother in law. The patient appeared to be annoyed with her son for not participating in his grandmother funeral arrangement and also, not showing

D-According to the patient, she is excited to be admitted to the take home bottle group today. The patient thanks this writer in a joyful manner. During the course of the session, this writer commends the patient as she's been compliant with treatment, mental health services, and maintaining a negative UDS result. In addition, this writer and the patient completed the first take home application. This writer advised the patient that this writer will be monitoring her mental health services every quarter to ensure the patient is maintaining compliance with her mental health treatment.

D- This writer met with the patient about his request for a change of counselor. According to the patient, he reported that his assigned counselor, Cherron does not make himself available for schedule appointment or even at the exact time of the appointment as the patient tends to wait for a quite some time. In the beginning, as per patient, his assigned counselor was punctual but everything has changed since the patient made a compliant against the counselor for not informing the patient about the need to validate his Rx Scripts and the severity of the matter to avoid entering a detox treatment. Since then, the patient feels that his relationship with his counselor has changed and feels that Cherron tactics appeared to be vengenaceful whereas

This writer received a call from the dosing window by Nurse Joann while in session regards to Elizabeth and having a scar under her eye. Upon meeting with Elizabeth, she appeared to be unease that she could not dose. This writer strongly advised the patient to calm down as this writer needs to gained clarification from the Nurse as to what is going on. There is concern about the scar under the patient eye; however, the patient proclaims that she is clumsy and fell down. The nurse informed the patient about the need to speak with the on call doctor for an order to be put in place in order for the patient to dose. Based on the nurse comment, the patient was getting upset and bit emotional. This writer then questioned the patient in order for

This writer was called while in session by Nursing regards to the patient, who had a scar under her eye. Upon meeting with the patient, she appeared to be unease as she explained to this writer in a emotional tone that she does not want to be seen for a session as she is scheduled for a session tomorrow. When asked as to what happen under her eye, she stated that she fell down and tends to be clumsy. According to the nurse from the dosing window, she needs to contact the on call medical doctor to address the matter before dosing; however, the patient was unwilling to wait as she expressed the need to leave the clinic. This writer attempted to calm the patient down and asked her about her day, work, and readdressing the scar. The patient then

D-The patient arrived on time for her scheduled appointment. According to the patient, she wants to increase on her dose, but needs more time to think about it without feeling pressured. The patient reports that she hasn't used any cocaine or THC for the past four days, at which this writer commends the patient for her effort to not using any drugs. The patient appeared to be very emotional discussing her husband's death and struggle with coping with the loss. This writer and the patient discussed coping skills whereas the patient is coping by being a grandmother to her grandchildren. The patient then discussed briefly about how her husband's death affected the family to the point that her son, who lives in Kenturky attempted to suicide at least 4 times. The patient tends to stay in communication with her son to ensure of his safety and well-being. As for the patient's daughter, the patient was again emotional discussing her daughter using heroin and being influenced by her boyfriend. The patient reports about talking to her daughter about her lifestyle, but nothing has prevail. This writer discussed with the patient about continuing to be a supportive mother and reaching out to her daughter to abstain from illicit drugs. This writer learned that the patient lives with the daughter in the home.

D/A: Mr. Brown had two appointments this week. On 02/06/17, Mr. Brown was transported to his appointment with Dr. Chua. According per Nurse Note, assessment states shortness of breath, coughing and tiredness. Consumer complained of pain, headache, back pain and arm pain. Consumer was assisted to his appointment with Dr. Redelcovecui in Dover at 2:42 p.m. On 02/08/17, according to the Nurse note, consumer was seen by Christiana Care Vising Nurse Associates for physical therapist evaluation. The Visiting Nurse stated that “consumer tolerated treatment well today.” Consumer met with his psychiatrist Dr. Capiro on02/06/17. Dr. Capiro provided consumer a comprehensive, psychiatric & medication review and an assessment of his needs. Consumer was

D-The patient arrived on time for his counseling session. Reported stability on his current dose and denies the need for a dose increase. The session was spent continuing from the last counseling session. The patient discuss the uncertainty to leave treatment in August due to improvement at home with his maternal aunt as both parties are getting along. Then the conversation shifted about the importance desires of discontinuing with his THC as the patient mentioned, " This is messing with my money.....I need to stop and I will stop. I got to do something with myself.....all my money is going to waste, you know." This writer and the patient explore the patient option about attending college as the patient discussed about wanting to have a stable

D-The patient attitude appears to be positive as he reports that he is pleased about his dose increase and did not have to use yesterday, at which this writer provided a positive feedback. The patient reports he feel he is stable at his current dose. The patient stated that he is working on his towards his recovery progress. The patient admits that he hasn't contacted CHS to reschedule his medical appointment and behavioral health services. The patient stated he will schedule the appointment. This writer urges the patient to do so and keep this writer updated. The patient then discussed how his daughter is his motivation with a smile. This writer addressed the AWOL status on 03/04/2016 and the patient reports he had overslept. This writer

D-The patient arrived on time for her appointment. AWOL yesterday due to her intake process at the Hartford Behavioral Health, which started at 9:30am, but ended at 12pm. This writer had the patient called the clinic for confirmation that she did in fact conduct the intake and is currently scheduled for counseling session with Josh Cohen on 07/01/2016 at 1:30pm. The patient is upset about not being able to get dose increase, even though it was approved to increase her dose by 5mgs due to her recent AWOL status. This writer advised the patient that she can received the dose increase within 3 days, but cannot receive no further AWOLs. This writer provided positive feedback to the patient about conducting her intake and asked about she felt

D-The patient arrived on time for her session. Upon meeting with the patient, she appeared odd and not smiling. This writer asked the patient if everything is alright and her responds was a yes. As this writer and the patient entered the office, the patient immediately discussed about detoxing from the program and when asked why? The patient vented about getting tired of clinic and how she knows to stay away from negative people. This writer continued to question the patient because her request did not make any sense and it happen suddenly; however, this writer advised the patient about seeking a consultation with medical to weigh in her option and also share with the patient about decreasing her dose to be stabilize at a lower dose, at which the patient then consider doing. While completing the dose change request as the patient requested to decrease her dose by 2mgs every week until she reaches 69mgs, this writer noticed the patient appeared to be not herself as she was seen rubbing her temple and then says, " Ah, man." This writer asked the patient as to what is really going on and the patient then shares about a recent altercation that occurred yesterday with another patient (#2732).

D-The patient arrived on time for her session. The patient shared her experience as she attended the cocaine group last week. Based on the patient body language and her demeanor, she enjoyed the group. The patient reports since attending the group, she hasn't used any cocaine for two days on Friday and Saturday. Addressing Sunday and Monday, the patient admits using crack cocaine, by smoking-2 bags because of her anxiety, at which this writer immediately addressed about alternatives. Furthermore, the patient discussed her fear going to detox facility and stated she does not want to go back. The patient believes she needs to attend more groups, at which this writer provided the patient with a list of self-help groups within her community. The

This client was on several psychotropic medications as well, during their counseling session he mad excuses by complaining about dizziness and/or stomach pain to avoid speaking. But after a few sessions she realized that his mother was constantly charging his medication without informing his support team and as his advocate she was able to do so. Donna seeked supervision for her consultant regarding and a meet was held to address the major concerns affects his counseling session. The medication providers and other support team staff informed his mother that medication needs as least three months to work in his system. His mother was changing his medication off of

D-The patient arrived on time for her session as she is scheduled for a counseling session. The patient reports about seeing her PCP recently and now, the patient has to conduct blood work to check on her overall health. No appointment is scheduled as the patient can do a walk-in. When asked when she is planning to do the blood work and her response was tomorrow as long as the clinic is not too busy. Reports stable on her dose and deny the need of taper off on her methadone when offered by this writer as she reports she is not ready. According to the patient she given birth to three children, but one passes away without discussing the detail. The patient's two oldest daughter drives school buses, but one of her daughter also works as an LPN.