HTML Preview Counseling Progress Note page number 1.
APPLESEED COMMUNITY MENTAL HEALTH CENTER, INC.
COUNSELING PROGRESS NOTE
Rev 03/2010
ACMHC COUNSELING PROGRESS NOTE
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Client Name (First, MI, Last)
Client No.
Others Present at Session: If others present, please list name(s) and relationship(s) to the client:
Client Present Client No Show/Cancelled
Stressor(s)/ Significant Changes in Client’s Condition (for face-to-face visit)
No Significant Change from Last Visit
Mood/Affect
Thought Process/Orientation
Behavior/Functioning
Substance Use
Danger to:
None Self Others Property
Ideation Plan Intent Attempt Other:
Goal(s)/Objective(s):
Therapeutic Intervention and Progress Toward Goal/s:
Recommendation for Modification and Update of the ISP if Applicable:
Provider Signature/Credentials
Date
Supervisor Signature/Credentials (if needed)
Date
Medicare “Incident to” Services Only
Supervisor Signature/Credentials (if needed)
Date
Supervisor Consultation (if needed)
Date of
Service
Staff ID
No.
Loc.
Code
Prcdr.
Code
Mod
1
Mod
2
Mod
3
Mod
4
Start
Time
Stop
Time
Total
Time
Diagnostic
Code