% General Medical Treatment Plan Template
% For primary care and chronic disease management
% Last updated: 2025

\documentclass[11pt,letterpaper]{article}

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\usepackage{amsmath,amssymb}
\usepackage[utf8]{inputenc}
\usepackage{graphicx}
\usepackage{array}
\usepackage{longtable}
\usepackage{booktabs}
\usepackage{enumitem}
\usepackage{xcolor}
\usepackage{fancyhdr}
\usepackage{lastpage}
\usepackage{tabularx}

% Header and footer
\pagestyle{fancy}
\fancyhf{}
\lhead{General Medical Treatment Plan}
\rhead{Page \thepage\ of \pageref{LastPage}}
\lfoot{Date Created: \today}
\rfoot{Confidential Patient Information}

% Title formatting
\usepackage{titlesec}
\titleformat{\section}{\large\bfseries}{\thesection}{1em}{}
\titleformat{\subsection}{\normalsize\bfseries}{\thesubsection}{1em}{}

\begin{document}

% Title
\begin{center}
{\Large\bfseries MEDICAL TREATMENT PLAN}\\[0.5em]
{\large General Medicine \& Chronic Disease Management}\\[0.5em]
\rule{\textwidth}{1pt}
\end{center}

\vspace{1em}

% ===== SECTION 1: PATIENT INFORMATION =====
\section*{1. Patient Information}

\textbf{HIPAA Notice}: All identifiable information must be removed or de-identified per Safe Harbor method before sharing this document. Remove: name, dates (except year), addresses, phone/fax, email, SSN, medical record numbers, account numbers, photos, and other unique identifiers.

\vspace{0.5em}

\begin{tabularx}{\textwidth}{|l|X|}
\hline
\textbf{Patient ID} & [De-identified code, e.g., PT-001] \\ \hline
\textbf{Age Range} & [e.g., 55-60 years] \\ \hline
\textbf{Sex} & [Male/Female/Other] \\ \hline
\textbf{Race/Ethnicity} & [If relevant to treatment] \\ \hline
\textbf{Date of Plan} & [Month/Year only] \\ \hline
\textbf{Provider} & [Name, MD/DO/NP/PA, Credentials] \\ \hline
\textbf{Facility} & [Healthcare facility name] \\ \hline
\end{tabularx}

\vspace{1em}

\subsection*{Active Medical Conditions}
\begin{itemize}[leftmargin=*]
    \item \textbf{Primary Diagnosis}: [Condition with ICD-10 code]
    \item \textbf{Secondary Diagnoses}:
    \begin{itemize}
        \item [Comorbidity 1 with ICD-10 code]
        \item [Comorbidity 2 with ICD-10 code]
        \item [Additional conditions as needed]
    \end{itemize}
\end{itemize}

\subsection*{Current Medications}
\begin{longtable}{|p{3.5cm}|p{2cm}|p{2cm}|p{5cm}|}
\hline
\textbf{Medication} & \textbf{Dose} & \textbf{Frequency} & \textbf{Indication} \\ \hline
\endfirsthead
\hline
\textbf{Medication} & \textbf{Dose} & \textbf{Frequency} & \textbf{Indication} \\ \hline
\endhead
Medication 1 & [e.g., 10mg] & [e.g., daily] & [Indication] \\ \hline
Medication 2 & [e.g., 50mg] & [e.g., BID] & [Indication] \\ \hline
[Add rows as needed] & & & \\ \hline
\end{longtable}

\subsection*{Allergies}
\begin{itemize}[leftmargin=*]
    \item \textbf{Drug Allergies}: [List medications and reactions, or NKDA]
    \item \textbf{Food/Environmental}: [If relevant to treatment]
\end{itemize}

\subsection*{Baseline Assessment}
\begin{itemize}[leftmargin=*]
    \item \textbf{Functional Status}: [Independent/requires assistance/dependent for ADLs]
    \item \textbf{Cognitive Status}: [Alert and oriented/impairment if present]
    \item \textbf{Social Support}: [Lives alone/with family, support system]
    \item \textbf{Key Baseline Values}: [e.g., HbA1c 8.5\%, BP 145/90, BMI 32, eGFR 55]
\end{itemize}

% ===== SECTION 2: DIAGNOSIS AND ASSESSMENT =====
\section*{2. Diagnosis and Assessment Summary}

\subsection*{Primary Diagnosis}
\textbf{Diagnosis}: [Full diagnosis name]\\
\textbf{ICD-10 Code}: [e.g., E11.9 for Type 2 Diabetes Mellitus without complications]\\
\textbf{Severity}: [Mild/Moderate/Severe or stage classification]\\
\textbf{Duration}: [Time since diagnosis]

\subsection*{Clinical Presentation}
[Describe current symptoms, functional limitations, and impact on quality of life. Include relevant exam findings and diagnostic test results.]

\subsection*{Risk Stratification}
\begin{itemize}[leftmargin=*]
    \item \textbf{Cardiovascular Risk}: [e.g., ASCVD 10-year risk 15\%]
    \item \textbf{Complications Risk}: [e.g., high risk for diabetic nephropathy]
    \item \textbf{Other Risk Factors}: [e.g., fall risk, frailty, polypharmacy]
\end{itemize}

\subsection*{Prognostic Considerations}
[Discuss expected disease course, factors affecting prognosis, and rationale for treatment intensity.]

% ===== SECTION 3: TREATMENT GOALS =====
\section*{3. Treatment Goals (SMART Format)}

\textbf{SMART Criteria}: All goals should be \textbf{S}pecific, \textbf{M}easurable, \textbf{A}chievable, \textbf{R}elevant, and \textbf{T}ime-bound.

\subsection*{Short-Term Goals (1-3 months)}

\begin{enumerate}[leftmargin=*]
    \item \textbf{Goal 1}: [e.g., Reduce HbA1c from 8.5\% to $<$7.5\%]
    \begin{itemize}
        \item \textit{Specific}: Reduce HbA1c by at least 1 percentage point
        \item \textit{Measurable}: HbA1c lab value
        \item \textit{Achievable}: With medication initiation and lifestyle changes
        \item \textit{Relevant}: Reduce microvascular complication risk
        \item \textit{Time-bound}: Achieve within 3 months (next follow-up)
    \end{itemize}
    
    \item \textbf{Goal 2}: [e.g., Decrease systolic blood pressure to $<$130 mmHg]
    \begin{itemize}
        \item \textit{Specific}: Achieve BP $<$130/80 mmHg
        \item \textit{Measurable}: Office and home BP measurements
        \item \textit{Achievable}: With medication optimization
        \item \textit{Relevant}: Reduce cardiovascular event risk
        \item \textit{Time-bound}: Within 8 weeks
    \end{itemize}
    
    \item \textbf{Goal 3}: [Additional short-term goal]
\end{enumerate}

\subsection*{Long-Term Goals (6-12 months)}

\begin{enumerate}[leftmargin=*]
    \item \textbf{Goal 1}: [e.g., Maintain HbA1c $<$7\% and prevent diabetic complications]
    \begin{itemize}
        \item \textit{Success criteria}: HbA1c $<$7\%, no new retinopathy/nephropathy/neuropathy
        \item \textit{Timeline}: Ongoing, assessed every 3-6 months
    \end{itemize}
    
    \item \textbf{Goal 2}: [e.g., Weight loss of 15 pounds (7\% body weight)]
    \begin{itemize}
        \item \textit{Success criteria}: BMI reduction from 32 to $<$30
        \item \textit{Timeline}: 6-12 months at 1-2 lbs/week
    \end{itemize}
    
    \item \textbf{Goal 3}: [e.g., Achieve LDL cholesterol $<$70 mg/dL]
    
    \item \textbf{Goal 4}: [Additional long-term goal as needed]
\end{enumerate}

\subsection*{Patient-Centered Goals}
\begin{itemize}[leftmargin=*]
    \item \textbf{Patient Priority 1}: [e.g., "Feel more energetic throughout the day"]
    \item \textbf{Patient Priority 2}: [e.g., "Avoid insulin injections if possible"]
    \item \textbf{Patient Priority 3}: [e.g., "Continue working full-time"]
\end{itemize}

% ===== SECTION 4: INTERVENTIONS =====
\section*{4. Interventions}

\subsection*{4.1 Pharmacological Interventions}

\begin{longtable}{|p{3cm}|p{2cm}|p{2cm}|p{6.5cm}|}
\hline
\textbf{Medication} & \textbf{Dose} & \textbf{Frequency} & \textbf{Instructions \& Rationale} \\ \hline
\endfirsthead
\hline
\textbf{Medication} & \textbf{Dose} & \textbf{Frequency} & \textbf{Instructions \& Rationale} \\ \hline
\endhead

[e.g., Metformin] & 500mg & BID & \textbf{Start:} Take with meals to reduce GI upset. \textbf{Titration:} Increase to 1000mg BID after 2 weeks if tolerated. \textbf{Target:} 2000mg daily. \textbf{Rationale:} First-line for T2DM, reduces hepatic glucose production. \\ \hline

[e.g., Lisinopril] & 10mg & Daily & \textbf{Instructions:} Take in morning. Monitor BP at home. \textbf{Titration:} May increase to 20mg if BP not at goal in 4 weeks. \textbf{Rationale:} ACE inhibitor for HTN and renal protection in diabetes. \\ \hline

[Additional medications] & & & \\ \hline
\end{longtable}

\textbf{Medication Safety Considerations}:
\begin{itemize}[leftmargin=*]
    \item \textbf{Drug Interactions}: [List relevant interactions to monitor]
    \item \textbf{Adverse Effects to Monitor}: [e.g., metformin - GI upset, lactic acidosis; lisinopril - cough, hyperkalemia, angioedema]
    \item \textbf{Contraindications}: [e.g., metformin if eGFR $<$30]
    \item \textbf{Pregnancy Category}: [If relevant to patient]
\end{itemize}

\subsection*{4.2 Non-Pharmacological Interventions}

\textbf{Lifestyle Modifications}:
\begin{itemize}[leftmargin=*]
    \item \textbf{Diet}:
    \begin{itemize}
        \item Mediterranean or DASH diet pattern
        \item Carbohydrate counting: 45-60g per meal
        \item Reduce saturated fat $<$7\% of calories
        \item Sodium restriction $<$2300mg daily
        \item Referral to registered dietitian
    \end{itemize}
    
    \item \textbf{Exercise}:
    \begin{itemize}
        \item Aerobic exercise: 150 minutes/week moderate intensity (e.g., brisk walking 30 min 5x/week)
        \item Resistance training: 2-3 sessions/week
        \item Reduce sedentary time, stand/move every 30 minutes
    \end{itemize}
    
    \item \textbf{Smoking Cessation}: [If applicable]
    \begin{itemize}
        \item Nicotine replacement therapy (patch, gum, lozenge)
        \item Consider varenicline or bupropion
        \item Behavioral counseling: 1-800-QUIT-NOW
        \item Target quit date: [specific date within 1 month]
    \end{itemize}
    
    \item \textbf{Weight Management}:
    \begin{itemize}
        \item Target: 7-10\% body weight loss over 6 months
        \item Caloric deficit: 500-750 kcal/day
        \item Weekly self-weighing and food diary
        \item Consider weight loss program or app
    \end{itemize}
    
    \item \textbf{Sleep Hygiene}:
    \begin{itemize}
        \item Target 7-9 hours nightly
        \item Consistent sleep schedule
        \item Screen for sleep apnea if indicated
    \end{itemize}
    
    \item \textbf{Stress Management}:
    \begin{itemize}
        \item Mindfulness or meditation practice
        \item Stress reduction techniques
        \item Adequate social support
    \end{itemize}
\end{itemize}

\textbf{Self-Management and Monitoring}:
\begin{itemize}[leftmargin=*]
    \item \textbf{Blood Glucose Monitoring}: [Frequency, e.g., fasting and 2hr post-prandial 3x/week]
    \item \textbf{Home Blood Pressure}: [Frequency, e.g., daily in AM, record in log]
    \item \textbf{Weight Tracking}: [e.g., weekly on same day/time]
    \item \textbf{Symptom Diary}: [Track relevant symptoms]
    \item \textbf{Medication Adherence}: [Pill box, reminder app]
\end{itemize}

\subsection*{4.3 Procedural and Referral Interventions}

\begin{itemize}[leftmargin=*]
    \item \textbf{Specialist Referrals}:
    \begin{itemize}
        \item [e.g., Endocrinology consultation for diabetes management]
        \item [e.g., Ophthalmology for annual dilated eye exam]
        \item [e.g., Podiatry for diabetic foot exam]
        \item [e.g., Nephrology if eGFR $<$30 or proteinuria]
    \end{itemize}
    
    \item \textbf{Diagnostic Testing Schedule}:
    \begin{itemize}
        \item [e.g., HbA1c every 3 months until at goal, then every 6 months]
        \item [e.g., Lipid panel annually]
        \item [e.g., Urine albumin-to-creatinine ratio annually]
        \item [e.g., Comprehensive metabolic panel every 6 months]
    \end{itemize}
    
    \item \textbf{Preventive Care}:
    \begin{itemize}
        \item Influenza vaccine annually
        \item Pneumococcal vaccines (PCV20 or PCV15+PPSV23)
        \item COVID-19 vaccination per current guidelines
        \item Age-appropriate cancer screenings
        \item [Other preventive measures as indicated]
    \end{itemize}
\end{itemize}

% ===== SECTION 5: TIMELINE AND SCHEDULE =====
\section*{5. Timeline and Schedule}

\subsection*{Treatment Phases}

\begin{tabularx}{\textwidth}{|l|X|X|}
\hline
\textbf{Phase} & \textbf{Timeframe} & \textbf{Focus} \\ \hline
Intensive Initiation & Weeks 1-4 & Medication titration, lifestyle education, baseline monitoring \\ \hline
Adjustment & Weeks 5-12 & Optimize medications, reinforce lifestyle changes, assess goal progress \\ \hline
Maintenance & Months 4-12 & Sustain improvements, prevent complications, long-term adherence \\ \hline
Ongoing & $>$12 months & Chronic disease management, annual assessments, update goals \\ \hline
\end{tabularx}

\subsection*{Appointment Schedule}

\begin{tabularx}{\textwidth}{|l|X|X|}
\hline
\textbf{Timepoint} & \textbf{Visit Type} & \textbf{Key Activities} \\ \hline
Week 2 & Phone/telehealth & Check medication tolerance, answer questions \\ \hline
Week 4 & Office visit & Medication adjustment, BP check, labs, review monitoring \\ \hline
Week 8 & Office visit & Assess progress toward goals, reinforce lifestyle \\ \hline
Month 3 & Office visit & HbA1c, comprehensive assessment, goal evaluation \\ \hline
Month 6 & Office visit & Reassess all goals, update plan, labs \\ \hline
Month 12 & Annual exam & Comprehensive evaluation, preventive care, specialty referrals \\ \hline
Ongoing & Every 3-6 months & Per chronic disease management protocol \\ \hline
\end{tabularx}

\subsection*{Milestone Assessments}

\begin{itemize}[leftmargin=*]
    \item \textbf{Month 1}: Medication tolerance, lifestyle initiation, home monitoring established
    \item \textbf{Month 3}: HbA1c $<$7.5\%, BP $<$130/80, 3-5 lb weight loss
    \item \textbf{Month 6}: HbA1c $<$7\%, sustained BP control, 8-10 lb weight loss
    \item \textbf{Month 12}: All long-term goals achieved or revised, complication screening complete
\end{itemize}

% ===== SECTION 6: MONITORING PARAMETERS =====
\section*{6. Monitoring Parameters}

\subsection*{Clinical Outcomes to Track}

\begin{longtable}{|p{4cm}|p{3cm}|p{3cm}|p{4cm}|}
\hline
\textbf{Parameter} & \textbf{Baseline} & \textbf{Target} & \textbf{Frequency} \\ \hline
\endfirsthead
\hline
\textbf{Parameter} & \textbf{Baseline} & \textbf{Target} & \textbf{Frequency} \\ \hline
\endhead

HbA1c & [e.g., 8.5\%] & $<$7\% & Every 3 months until stable, then every 6 months \\ \hline
Fasting Glucose & [e.g., 165 mg/dL] & 80-130 mg/dL & Home monitoring per schedule \\ \hline
Blood Pressure & [e.g., 145/90] & $<$130/80 mmHg & Daily home, every office visit \\ \hline
Weight/BMI & [e.g., 210 lb, BMI 32] & 195 lb, BMI $<$30 & Weekly at home, every visit \\ \hline
LDL Cholesterol & [e.g., 135 mg/dL] & $<$70 mg/dL & Every 6-12 months \\ \hline
eGFR & [e.g., 55 mL/min] & Stable, $>$45 & Every 6 months \\ \hline
Urine ACR & [e.g., normal] & $<$30 mg/g & Annually \\ \hline
[Add additional parameters] & & & \\ \hline
\end{longtable}

\subsection*{Assessment Tools and Scales}

\begin{itemize}[leftmargin=*]
    \item \textbf{Diabetes Distress Scale}: [Assess emotional burden of diabetes management]
    \item \textbf{SF-12 or PROMIS}: [Quality of life assessment]
    \item \textbf{Medication Adherence}: [Morisky scale or refill tracking]
    \item \textbf{[Other relevant scales]}: [e.g., PHQ-2 for depression screening]
\end{itemize}

\subsection*{Safety Monitoring}

\begin{itemize}[leftmargin=*]
    \item \textbf{Hypoglycemia}: Frequency of blood glucose $<$70 mg/dL, symptoms
    \item \textbf{Medication Adverse Effects}: GI upset, cough, dizziness, other symptoms
    \item \textbf{Hyperkalemia}: Potassium level if on ACE inhibitor/ARB
    \item \textbf{Renal Function}: Monitor eGFR for metformin safety, ACE/ARB effects
\end{itemize}

\subsection*{Thresholds for Intervention}

\begin{itemize}[leftmargin=*]
    \item \textbf{Urgent}: Blood glucose $>$300 or $<$50, BP $>$180/110, chest pain, severe symptoms
    \item \textbf{Escalate Treatment}: No improvement in HbA1c after 3 months, BP above goal after 8 weeks
    \item \textbf{Modify Plan}: Intolerable side effects, patient preference change, new comorbidities
\end{itemize}

% ===== SECTION 7: EXPECTED OUTCOMES =====
\section*{7. Expected Outcomes}

\subsection*{Primary Outcome Measures}

\begin{itemize}[leftmargin=*]
    \item \textbf{Glycemic Control}: HbA1c reduction of 1.5\% expected with metformin + lifestyle
    \item \textbf{Blood Pressure Control}: SBP reduction of 10-15 mmHg with ACE inhibitor
    \item \textbf{Weight Reduction}: 7-10\% body weight loss over 6-12 months
    \item \textbf{Lipid Control}: LDL reduction of 30-40\% with statin therapy
\end{itemize}

\subsection*{Timeline for Improvement}

\begin{itemize}[leftmargin=*]
    \item \textbf{Weeks 1-2}: Improved fasting glucose, initial weight loss
    \item \textbf{Weeks 4-8}: BP at goal, medication tolerance established
    \item \textbf{Month 3}: HbA1c improvement visible
    \item \textbf{Months 6-12}: Sustained control, complication risk reduction
\end{itemize}

\subsection*{Long-Term Prognosis}

With adherence to this treatment plan, expected outcomes include:
\begin{itemize}[leftmargin=*]
    \item Reduced microvascular complication risk (retinopathy, nephropathy, neuropathy)
    \item Decreased cardiovascular event risk (MI, stroke)
    \item Improved quality of life and functional status
    \item Maintained independence and ability to work
    \item [Additional expected benefits]
\end{itemize}

% ===== SECTION 8: FOLLOW-UP PLAN =====
\section*{8. Follow-Up Plan}

\subsection*{Scheduled Appointments}

\begin{itemize}[leftmargin=*]
    \item \textbf{Next Visit}: [Date/timeframe - e.g., 4 weeks from today]
    \item \textbf{Visit Purpose}: [Medication adjustment, lab review, goal assessment]
    \item \textbf{Ongoing Schedule}: See Appointment Schedule in Section 5
\end{itemize}

\subsection*{Communication Plan}

\begin{itemize}[leftmargin=*]
    \item \textbf{Between-Visit Contact}: Phone call at 2 weeks to assess medication tolerance
    \item \textbf{Lab Results}: Will call with results within 3-5 business days
    \item \textbf{Questions}: Call office at [phone], patient portal messaging
    \item \textbf{Prescription Refills}: Via patient portal or pharmacy automated refill
\end{itemize}

\subsection*{Emergency Procedures}

\textbf{Call 911 immediately for}:
\begin{itemize}[leftmargin=*]
    \item Chest pain, shortness of breath, or stroke symptoms
    \item Severe hypoglycemia with confusion or loss of consciousness
    \item Severe allergic reaction (angioedema, anaphylaxis)
\end{itemize}

\textbf{Call office same day for}:
\begin{itemize}[leftmargin=*]
    \item Blood glucose consistently $>$300 or $<$60 mg/dL
    \item Blood pressure $>$180/110 mmHg
    \item Persistent severe medication side effects
    \item Fever, infection, or acute illness (may need medication adjustment)
\end{itemize}

\subsection*{Transition Planning}

\begin{itemize}[leftmargin=*]
    \item \textbf{If Hospitalized}: Provide this treatment plan to hospital team, resume medications on discharge
    \item \textbf{Specialist Co-Management}: Share plan with all specialists, coordinate medication changes
    \item \textbf{Future Considerations}: [e.g., may need insulin if oral medications insufficient]
\end{itemize}

% ===== SECTION 9: PATIENT EDUCATION =====
\section*{9. Patient Education}

\subsection*{Condition Understanding}

Patient education provided on:
\begin{itemize}[leftmargin=*]
    \item \textbf{Disease Pathophysiology}: [e.g., How Type 2 diabetes affects blood sugar and organs]
    \item \textbf{Natural History}: [Course without treatment vs. with optimal management]
    \item \textbf{Complication Risks}: [Microvascular and macrovascular complications]
    \item \textbf{Treatment Rationale}: [Why each intervention is recommended]
\end{itemize}

\subsection*{Self-Management Skills}

Training provided on:
\begin{itemize}[leftmargin=*]
    \item \textbf{Glucose Monitoring}: How to use glucometer, when to test, target ranges, record keeping
    \item \textbf{Blood Pressure Monitoring}: Proper technique, timing, logging
    \item \textbf{Medication Administration}: How to take each medication, timing with meals
    \item \textbf{Diet and Nutrition}: Carb counting, meal planning, label reading
    \item \textbf{Exercise Safety}: Starting gradually, checking glucose before/after exercise
    \item \textbf{Sick Day Management}: When to call, medication adjustments during illness
\end{itemize}

\subsection*{Warning Signs}

Patient instructed to recognize and respond to:
\begin{itemize}[leftmargin=*]
    \item \textbf{Hypoglycemia}: Shakiness, sweating, confusion - treat with 15g fast carbs
    \item \textbf{Hyperglycemia}: Excessive thirst, urination, fatigue - check glucose, call if $>$300
    \item \textbf{Cardiovascular Symptoms}: Chest pain, SOB, leg swelling - seek immediate care
    \item \textbf{Diabetic Foot Problems}: Wounds, numbness, pain - immediate podiatry evaluation
    \item \textbf{Medication Side Effects}: [Specific symptoms requiring dose adjustment or discontinuation]
\end{itemize}

\subsection*{Resources and Support}

\begin{itemize}[leftmargin=*]
    \item \textbf{Educational Materials}: [Handouts provided on diabetes, diet, medications]
    \item \textbf{Diabetes Self-Management Education}: Referral to DSMES program
    \item \textbf{Nutrition Counseling}: Registered dietitian appointment scheduled
    \item \textbf{Support Groups}: [Local or online diabetes support groups]
    \item \textbf{Technology}: [Glucose tracking app, BP log app, medication reminder]
    \item \textbf{Financial Assistance}: [Medication assistance programs, community resources]
\end{itemize}

% ===== SECTION 10: RISK MITIGATION =====
\section*{10. Risk Mitigation and Safety}

\subsection*{Medication Safety}

\begin{itemize}[leftmargin=*]
    \item \textbf{Hypoglycemia Risk}:
    \begin{itemize}
        \item Low risk with metformin alone (no insulin/sulfonylureas)
        \item Patient educated on symptoms and treatment (15-15 rule)
        \item Glucose monitoring more frequent if starting insulin in future
    \end{itemize}
    
    \item \textbf{Lactic Acidosis Risk} (metformin):
    \begin{itemize}
        \item Monitor renal function every 6 months
        \item Hold metformin if eGFR $<$30 or during acute illness/dehydration
        \item Discontinue 48 hours before contrast procedures
    \end{itemize}
    
    \item \textbf{Hyperkalemia/Renal Impairment} (ACE inhibitor):
    \begin{itemize}
        \item Check potassium and creatinine 1-2 weeks after initiation
        \item Monitor every 6 months ongoing
        \item Hold during severe dehydration or acute kidney injury
    \end{itemize}
\end{itemize}

\subsection*{Complication Prevention}

\begin{itemize}[leftmargin=*]
    \item \textbf{Cardiovascular}: Aspirin 81mg if ASCVD risk $>$10\%, BP/lipid control
    \item \textbf{Retinopathy}: Annual dilated eye exam, glucose control
    \item \textbf{Nephropathy}: ACE inhibitor renal protection, annual urine ACR, BP control
    \item \textbf{Neuropathy}: Annual foot exam, glucose control, foot care education
    \item \textbf{Falls}: Screen for orthostatic hypotension, avoid overtreatment
\end{itemize}

\subsection*{Polypharmacy and Drug Interactions}

\begin{itemize}[leftmargin=*]
    \item Regular medication reconciliation at each visit
    \item Screen for drug-drug interactions with new medications
    \item Deprescribe unnecessary medications
    \item Consider pill burden and simplify regimen when possible
\end{itemize}

\subsection*{Emergency Action Plan}

\begin{tabularx}{\textwidth}{|l|X|}
\hline
\textbf{Situation} & \textbf{Action} \\ \hline
Severe hypoglycemia ($<$50, confusion) & Give glucagon injection if available, call 911 \\ \hline
Hyperglycemia $>$300 with symptoms & Drink water, check ketones if T1DM, call office \\ \hline
Chest pain or stroke symptoms & Call 911 immediately \\ \hline
Medication side effect & Stop medication, call office same day \\ \hline
Acute illness/vomiting & Sick day protocol, call office for guidance \\ \hline
\end{tabularx}

% ===== SECTION 11: PROVIDER SIGNATURE =====
\vspace{2em}

\section*{11. Provider Signature and Attestation}

I have reviewed this treatment plan with the patient. The patient demonstrates understanding of the diagnosis, treatment rationale, goals, interventions, self-management requirements, warning signs, and when to seek emergency care. The patient agrees to this treatment plan and has had the opportunity to ask questions. Shared decision-making was employed, and patient preferences were incorporated.

\vspace{1em}

\begin{tabular}{ll}
Provider Signature: & \rule{7cm}{0.5pt} \\[1em]
Provider Name/Credentials: & \rule{7cm}{0.5pt} \\[1em]
Date: & \rule{4cm}{0.5pt} \\[2em]
\end{tabular}

\subsection*{Patient Acknowledgment (Optional)}

I have reviewed this treatment plan with my healthcare provider. I understand my diagnosis, treatment goals, medications, lifestyle recommendations, self-monitoring requirements, and when to seek medical attention. I agree to follow this plan and contact my provider with questions or concerns.

\vspace{1em}

\begin{tabular}{ll}
Patient/Representative Signature: & \rule{7cm}{0.5pt} \\[1em]
Date: & \rule{4cm}{0.5pt} \\
\end{tabular}

\vspace{2em}
\begin{center}
\rule{\textwidth}{1pt}\\
\textbf{End of Treatment Plan}\\
This document contains confidential patient information protected by HIPAA.
\end{center}

\end{document}

% ========== NOTES FOR USERS ==========
%
% CUSTOMIZATION INSTRUCTIONS:
% 1. Replace all bracketed placeholders [like this] with patient-specific information
% 2. Remove or add sections as appropriate for the clinical condition
% 3. Ensure all SMART goals meet criteria (Specific, Measurable, Achievable, Relevant, Time-bound)
% 4. Include evidence-based interventions per current clinical guidelines
% 5. De-identify all protected health information before sharing
%
% COMPILATION:
% pdflatex general_medical_treatment_plan.tex
%
% VALIDATION:
% Run check_completeness.py and validate_treatment_plan.py before finalizing

