Little Hands and Creations Client Session Note Form
Session Authorization
Date/Fecha
-
Month
-
Day
Year
Date
Type of Service
Please Select
Intensive In-Community (IIC)
Behavioral Assistant (BA)
Mentoring
Tutoring
Parent Mentoring
Transportation
Community Based Supports (CBS)
Postive Behavior Supports (PBS)
Art Therapy
Respite
Individual Support
ABA (BT)
Number of hours
Time of Start
Hour Minutes
AM
PM
AM/PM Option
Time End
Hour Minutes
AM
PM
AM/PM Option
Client’s Name/Cliente El Nombre:
First Name
Last Name
Employee Signature/
Employee Name
First Name
Last Name
SESSION NOTE
How was session delivered?
Please Select
In-Person
Virtual (audio)
Virtual (audio/visual)
phone call
Submit
Should be Empty: