Sample Case Notes Form

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Sample Case Notes
Editor’s note: Case notes are intended to help practitioners keep track of actions that have taken place in a case and to keep
track of important dates, such as interviews or hearings, etc. The case notes should be fastened to the inside left cover of the
case file folder; preferably by two-hole ACCO fasteners. Do not staple the case notes into the file folder because staples
make it more difficult for the reader to maneuver through the case notes. As you finish each page of case notes, you add a
new page on top of the old page. When someone reads the case notes, they will appear in reverse chronological order so
that you read back in time as to what has gone on before in the case.
CASE NOTES
Please print clearly so that others who must read this file can understand your notes. If you use abbreviations, then please
provide a key so that people can understand your abbreviations.
Client name (first, middle, last):
A-number (if any):
Agency file number:
Street address:
City, state, zip:
Cell telephone:
Home phone:
E-mail:
Name of emergency contact:
Telephone number of emergency contact:
E-mail address of Emergency contact:
DATE
INITIALS
ACTIVITY

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