Progress Note

Applied Home Care Services Caring is our commitment
Individuals Name
Date

MonthDayYear
Date
Start Time

Hour Minutes

AM/PM Option
End Time

Hour Minutes

AM/PM Option
SUMMARY OF THE DAY Give a Chronological Summary (Includes Time of Activities and Individuals AND Response to each Activity) **Include if individual attended a Medical Appointment
Did the Physician prescribe any new medications?

YESNO
If yes, was the 1st, 2nd, 3rd dose taken on your shift:

YESNO
If yes, indicate which dose:

1st dose2nd dose3rd dose
Document within the first 20 Minutes if there were any adverse side effects. If yes, Describe:
ISP GOALS

(Track ISP Goals on ISP Tracking Sheet)
Did the Individual Work of any ISP Goal?

YESNO
If yes, Describe each goal objective (ex. Worked on Goal A1, B1 etc.,) Prompting Level Required for Goal (ex. Work on goal independently or required V1, V2, etc AND Individual's Response to goals AND Progress Made or Lack of Progress Towards ISP Goal.

BEHAVIORS

(Behaviors must also be documented on ABC Sheet)
Did the individual have any behaviors?

YESNO
Did the individual have any behaviors?
If yes provide a Brief summary AND Intervention used:
Community Outing
Did the individual choose to participate in the scheduled community outing activity?

YESNO
If yes Describe the Activity AND the individuals Response to the Outing:
If No, Explain (Include if Individual chose another activity of his/her choice):
RELATIONSHIPS/MEETINGS ETC.
Was the individual involved in any visits from family or other persons, phone calls from/to friends/family, meetings, etc.

YESNO
If YES provide a brief explanation
Progress Report Completed By:
Print Name
Title: DCS
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

RELATIONSHIPS/MEETINGS ETC.