245D Progress Note Form

When you write a progress note, explain what activity happened and what help you gave to the person.

PLEASE NOTE: THIS IS MANDATORY NOT OPTIONAL

Be sure to include:

● What you did to support and assist the client toward their person-centered goals

● How you supported and assisted the client based off of their specific needs stated in their support plan

● What you did during your shift

● Note if there are any decline or improvement in the clients physical and/or mental health

Some examples of help you can write about:
● Giving reminders or prompts to help the person finish a task
● Doing the task for the person if they cannot do it
● Watching to see if the person needs help
● Giving kind words or support
● Helping the person stay focused
● Taking care of things like clothes, supplies, or equipment
● Helping with medicine
● Making food
● Helping the person stay safe outside (like crossing the street)
● Helping the person use special tools or devices
● Helping the person talk or communicate
● Helping read, fill out, and understand mail or paperwork

When Writing Progress Notes:
● THESE NOTES MUST BE 3-4 SENTENCES LONG.
● THESE NOTES CANNOT BE 1 OR 2 WORDS.
● Do not use slang, short words, or texting language.

PLEASE NOTE: THIS IS MANDATORY NOT OPTIONAL

Progress Note Examples

Example #1

Today, I assisted the individual with organizing their personal items and
managing their household tasks. I provided reminders to help them
complete their daily chores and helped with reading and understanding
important mail. I also supported them in preparing a meal, offering
encouragement, and ensuring they were safe in the kitchen. The person
appeared to have no new needs today.

Example #2
Today, I supported the individual during a trip to the local grocery store. I
helped them make a shopping list, gave reminders to stay on task, and
assisted with choosing items. I also provided guidance on how to cross the
street safely and reminded them to follow traffic signals. Afterward, we sat
down at a nearby café, where I assisted with reading and understanding a
letter they had received, and made sure they felt comfortable and
supported during our outing.

Example#3
During my shift, I provided overnight supervision to ensure the individual's
safety and well-being. I checked in on them every hour, offering assistance
with using the bathroom and making sure they were comfortable in bed. I
also helped by reading through some important letters they had received
and explaining the contents. No issues were observed overnight, and the
person slept well without requiring additional support.

Staff Full Name *

First NameLast Name

Client Full Name *

First NameLast Name

Service Provided *

What type of supports were provided during your shift?*

Assistance with Activities of Daily Living (such as getting dressed, Personal Eating Hygiene, etc),Assistance with Increasing Community Participation (such as daily errands,attending events, going to a restaurant, purchasing items, travel training, etc.)Assistance with Increasing Independence (such as helping the individual learn todo laundry, cook, clean, dress, grocery shop, pay for items, etc.)Other

Description of Activity (Progress Note): *

Additional Notes / Issues:

Service Date *

Date

Signature

Waiver 245D Progress Notes