Michael PRP Progress Note

PRP Progress Note
Client's Name:

First NameLast Name
Client Date of Birth:

MonthDayYear
Date
Client’s Therapist:

First NameLast Name
Date of Contact:

MonthDayYear
Date
Place of Service:

On-Site:Off-Site
if offsite, include location:
Time From

Hour Minutes

AM/PM Option
Time To

Hour Minutes

AM/PM Option
Type of Visit:
Client’s diagnosis:
If other, (minor only) enter diagnosis:
Select Service Code
Service Tpye:

AssessmentPRP Encounter AdultPRP Encounter Minor
Faceto Face:

H0002H2018-U3H2016-U2
Phone:

H0002UBH2018-U3UBH2016-U2UB
Video:

H0002-GTH2018-U3GTH2016-U2GT
Client’s Appearance
Dress:

appropriateinappropriate
Hygiene:

goodpoor
Eye Contact:

appropriatepoor
Manifest Behavior
Behavior:

CooperativeOppositionalPassiveDestructiveAttention SeekingRestlessTicsAggressiveOther
Speech:

Normal rateRhythmtoneArticulation Defect; PressuredLoudSlurredSlowedMuteSoftOther
Affect/Mood:

AppropriateAnxiousDepressedFlatLabileHostileOther
Thought Process:

Goal-DirectedCircumstantialTangentialFlight of ideasBlockingOther
Perceptual Disturbances
Hallucinations:

auditoryvisualtactileIllusionNot elicitedOther
Attention:

DistractibleAppropriateOther
Concentration:

GoodFairPoorOther
Insight/judgement:

GoodFairPoorOther
Goals
Goal Addressed:
Objective
A) Method/Intervention:
B) Method/Intervention:
Visit Summary (Detailed content of visit and intervention/s):
Plans for next visit:
Date for next visit:

MonthDayYear
Date
Signature
Staff Name:

First NameLast Name
Staff Title
Signature

Clear
Date

MonthDayYear
Date
Supervisor Signature
Supervisor's Name

First NameLast Name
Supervisor's Title
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

PRP Progress Note

Select Service Code

Client’s Appearance

Manifest Behavior

Perceptual Disturbances

Goals

Signature

Supervisor Signature