Appleseed Community Mental Health Center, Inc. Counseling Progress Note
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8APPLESEED COMMUNITY MENTAL HEALTH CENTER, INC.
COUNSELING PROGRESS NOTE
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:
Ideation
Plan
Intent
Attempt
Other:
None
Self
Others
Property
Goal(s)/Objective(s):
Therapeutic Intervention and Progress Toward Goal/s
:
Recommendation for Modification and Update of the ISP if Applicable:
Date
Provider Signature/Credentials
Supervisor Signature/Credentials (if needed)
Date
Date
Medicare “Incident to” Services Only
Supervisor Signature/Credentials (if needed)
Supervisor Consultation (if needed)
Staff ID
Date of
Loc.
Prcdr.
Mod
Mod
Mod
Mod
Start
Stop
Total
Diagnostic
No.
Service
Code
Code
1
2
3
4
Time
Time
Time
Code
Rev 03/2010
ACMHC COUNSELING PROGRESS NOTE
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Parent category: Medical