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HTML Preview Counseling Progress Note page number 1.
1
A
PPLESEED COMMUNIT
Y MENTA
L HEALTH
CENTER, INC.
COUNSELING PR
OGRESS
NOTE
Rev 03/2010
ACMHC COU
NSELING PROGRESS
NOTE
Page 1
of
1
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
Str
ess
or
(s
)/
Sign
if
ican
t
Chan
ge
s in
C
lie
nt’
s
Cond
it
ion
(f
or f
a
ce-
to
-face
v
isi
t)
No Significant Change from Last V
isit
Moo
d
/Aff
ect
Tho
ug
ht
Pro
ces
s/
Ori
en
tat
ion
Beh
av
ior
/Fun
c
tion
in
g
Sub
sta
nce
U
se
Danger to:
None
Self
Othe
rs
Property
Ideation
Plan
In
tent
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 On
ly
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
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