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Psychotherapy Progress Note
Use this note to document individual, family or couples psychotherapy sessions and person s response to the intervention during a specific contact.
Data FieldPerson s NameRecord the first name, last name, and middle initial of the person. Order of name is atagency discretion.Record NumberRecord your agency s established identification number for the person.Person s DOBRecord the person s date of birth.Organization Name:Record the organization for whom you are delivering the service.ModalityCheck appropriate box to indicate the type of session: individual, family or couple.List Name(s) of Person(s)Check appropriate box to indicate whether the person is Present, is a NoPresentShow/Cancelled or the Provider Cancelled. For cancellations, complete Explanation asneeded. Check appropriate box to indicate if others are present, list name(s) andrelationship(s) to person.Person s Report ofDocument person s self-report of progress towards goals since last session includingProgress Towardsother sources of information, such as family, case manager, etc..Goals/Objectives SinceLast SessionNew Issue(s) PresentedThere are four options available for staff using this section of the progress note:Today1.If person does not report/present any new issues, mark None Reported and proceed to planned intervention/goals.2.If person reports a new issue that was resolved during the session checkthe New Issue resolved, no CA Update required box. Briefly documentthe new issue, identify the interventions used in the TherapeuticInterventions Section and indicate the resolution in the Response Sectionof the progress note.Example: Person described being involved in a minor car accident today.Person was not hurt but expressed concern regarding expense of carrepair. Person felt more relieved after identifying ways to cover expenseover the next two weeks.3.If person presents an issue that has been previously assessed and forwhich Goals/Objectives and services have been ordered, then theinformation may be briefly documented as an indicator of the progress orlack of progress achieved.4.If person presents any new issue(s) that represent a therapeutic need thatis not already being addressed in the IAP, check box indicating a CAUpdate Required and record notation that new issue has been recordedon a Comprehensive Assessment Update of the same Date and writedetailed narrative on the appropriate CA Update as instructed in thismanual. Also, the newly assessed therapeutic information may require anew goal, objective, therapeutic intervention or service that will requirefurther use of the IAP Review/Revision form.Example: Person reported for the first time that she was a victim ofabuse/neglect at the age of twelve as recorded on theComprehensive Assessment Update of this date.
Data FieldPerson s Condition InstructionsPerson s Condition:This is a mini-mental status exam. Check appropriate box to indicateperson s condition or to indicate No Change. Also, describe any changes.Mood/affectNote: Notable is defined as behavior or symptoms different from the person sThoughtbaseline status. These changes may be signs the person is experiencingProcess/Orientationincreased problems or distress or may indicate an improvement inBehavior Functioningfunctioning/symptoms/behavior.Medical ConditionExample: Thought process/orientation is marked Notable and theSubstance Usecomments are: John is distracted and responding to voices he ishearing today. However, if John s baseline is that he always hear somevoices and responds, a Notable comment would not be needed unlessthe intensity or impact of the voices on John is significantly differentthan his baseline.Risk AssessmentCheck appropriate box(es) to indicate area(s) and type(s) of risk or checkNone. Describe types of risky behavior such as cutting, mutilation, unsafe sexetc. under Additional Comments.If any box except None is marked, be sure to document in theTherapeutic Interventions Delivered in Session section how this wasaddressed and resolved.Data FieldGoal(s) Addressed as Per Individualized Action PlanGoal(s) as Addressed PerIdentify the specific goal(s) and objectives in the Individualized Action PlanIndividualized Action Planbeing addressed during this intervention. All interventions must bedocumented in a progress note and must be targeted towards specificgoal(s)/objective(s) in the Individualized Action Plan except as noted aboveunder new issues.Data FieldTherapeutic Interventions and Progress InstructionsTherapeutic InterventionsDescribe the specific therapeutic interventions used in the psychotherapyDelivered in Sessionsession to assist the person in realizing the goals and objectives addressedas the focus of this particular session.Individual Example: Helped person to develop a list of those situationsat work which most often result in him becoming angry and acting out.Demonstrated and role-played de-escalation technique of leaving areaand self-calming, using relaxation techniques.Couples Example: Provider asked the person and his partner to listento each other for five minutes and then to tell the other person whatthey heard.Family Example: Family members were asked to take turns sayingsomething positive about each other and then to express how difficultthat is. Then they were asked to talk about what impact doing that hasupon the person s depressed mood.Person s Response toThis section should address BOTH:Intervention/ Progress" The person s response to the intervention - Include evidence the personparticipated in the session and how, and information about how the personToward Goals andwas able to benefit from the intervention e.g. through active participation,Objectivesbetter understanding of issues, understanding or demonstration of new skills." Progress towards goals and objectives - Include an assessment of how thesession has moved the person closer, further away, or had no discernableimpact on meeting the session s identified goal(s) and objective(s).Individual Example: The person actively participated by listing triggers. Agreedto practice de-escalation and calming techniques during the next two weeks,particularly on the job; he is very anxious about this. The person agreesidentifying those situations in which his anger is a problem is a big step forwardfor him. Agrees he must continue to work on this or possibly lose his job.Couples Example: As Allen described a recent argument with his partner, hewas able to recognize how their communication style exacerbates his anxiety.Allen reported becoming increasingly anxious in the session each time hispartner interrupted him. Once identified, Allen was better able to assert himselfwhile his partner was able to decrease the number of interruptions.Family Example: Amy was able to tell her parents that their criticisms of herschoolwork made her feel bad and she needed more positive feedback andsupport from them. Her parents could not recognize that their comments werecritical and insisted she was misunderstanding them. Although Amy did notreceive the support she requested, she showed good progress as she was ableto continue discussing the issue with her parents without escalating.Data FieldAdditional Information/PlanPlan AdditionalThe clinician should document future steps or actions planned with the person such asInformationhomework, plans for the next session, etc.Plan to overcome lack of progress - If no progress is made over time, this sectionshould also include how the counselor intends to change his/her strategy to producepositive change in the person.Document additional pertinent information that is not appropriate to documentelsewhere.Example: Person will keep a mood journal to identify triggers to explosiveepisodes and bring to next session to review and discuss alternative responses.Data FieldMedicare Incident To InstructionsMedicare Incident to Check the box when service is to be billed using the incident to billing rules.Services Only (ifapplicable)Name and credentials ofEnter the name of the supervising professional who provided the on-siteMedicare Provider on Site:supervision of the incident to service.Note: The presence of an appropriate licensed supervising professional isone of the key requirements for an incident to service. In some cases, theservice is billed under the number of the supervising professional. In others,the attending professional s number should be used. Providers shouldconsult with their Medicare Carrier s Local Medical Review Policies.Data FieldSignature InstructionsProvider NameLegibly print the provider s name.Provider Signature/Legibly record provider s signature, credentials and date.CredentialsSupervisor NameIf required, legibly print name of supervisor.SupervisorIf required, legibly record supervisor s signature, credentials and date.Signature/CredentialsPerson s Signature andThe person is given the option to sign the Progress Note. If completing the note afterdatethe session and/or if using electronic notes, person can sign at next session.Next AppointmentIndicate the date and time of the next scheduled appointment.Instructions to completethe Billing Strip:Data FieldBilling Strip Completion InstructionsDate of ServiceDate of session/service providedProvider NumberSpecify the individual staff member s provider number as defined bythe individual agency.Location CodeIdentify Location Code of the service. Providers should refer to theiragency s billing policies and procedures for determining which codesto use.Procedure CodeIdentify the procedure code that identifies the service provided anddocumented. Providers should refer to their agency s billing policiesand procedures for determining which codes to use.Modifier 1, 2, 3 and 4Identify the appropriate modifier code to be used in each of thepositions. Providers should refer to their agency s billing policies andprocedures for determining which codes to use for Modifiers 1, 2 3and/or 4.Start TimeIndicate actual time the session started. Example: 3:00 PMStop TimeIndicate actual time the session stopped. Example: 3:34 PMTotal TimeIndicate the total time of the session. Example: 34 minutesDiagnostic CodeUse the numeric code for the primary diagnosis that is the focus ofthis session. Providers should use either ICD-9 or DSM code asdetermined by their agency s billing policies and procedures.
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