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Using the information you have gathered and hypothesized, fill in the boxes below:
Targeted Outcome 1:
1. We would like for the patient to:
2. Short term objectives that reflect the outcomes
1. 2. 3.
3. Types of intervention selected and rationale for selection
Intervention: Rationale:
4. Specific intervention methods used under each type of intervention selected
1. 2. 3. 4. 5.
Targeted Outcome 2: