ABH Daily Progress Report

ABH/Mental Health Daily Shift Progress Report

(must be completed after every shift)
Consumer Information*

First NameLast Initial
Service Provider Name*

First NameLast Name
Start Time*

Hour Minutes

AM/PM Option
End Time

Hour Minutes

AM/PM Option
Date of Service*

MonthDayYear
Date
What Service was provided?*

Recovery AssistantChore
Level of Assistance (LOA) Definitions:

5. MAXIMUM ASSISTANCE – Unable to meet minimal standards of behavior or functioning in order to participate in daily living activities or performance of basic tasks approximately 75% of time. Cues – Step by step physical gestures, pointing and demonstrations Prompts/Coaching - Step by step physical demonstrations with visual and verbal directions that prompt the participant to perform the skills and/or tasks. 4. MODERATE ASSISTANCE – Needs constant cognitive assistance such as 1:1 cueing, prompting/coaching or demonstrations to sustain or complete simple, repetitive activities or tasks safely and accurately approximately 50% of time. Cues – Step by step verbal & written directions/hints to help organize thoughts. Prompts/Coaching – Step by step verbal directions. 3. MINIMUM ASSISTANCE – Needs periodic cognitive assistance (cueing and/or prompting/coaching) to correct mistakes, check for safety and/or solve problems approximately 25% of time. Cues - Verbal & written hints related to the task. Prompts/Coaching – written and/or verbal directions. 2. STANDBY ASSISTANCE – Supervision by one person is needed to enable the individual to perform new procedures for safe and effective performance. Cues – Visual demonstrations related to the task. Prompts/Coaching – Visual and physical directions that prompt the participant to perform the skills and/or tasks. 1. INDEPENDENT – No physical or cognitive assistance needed to perform activities or tasks. Please check the skill area and the LOA provided. Add comments if applicable. The goal of each client is to increase independence in all areas of daily living.
Personal Hygiene*
Bathing Dressing Oral Care Clean Clothes Hair Care Nail Care Obtain proper hygiene supplies
Household Task*
Change Linens Vacuum/Dust Clean Kitchen Clean Bedroom Clean Living Room Clean Bathroom Discard Garbage Mop floor Obtain Proper Cleaning Supplies Regulating Home Temperature Pest Control
Personal Laundry*
Wash Clothes Dry Clothes Fold Clothes Iron Clothes Mend Clothes
Food Management*
Meal Planning Food Selection Food Storage Safe Cooking Habits Order Food in restaurants Acceptable Table Manners
Personal Health and Safety*
Review use of medical emergency services Schedule Medical Appointments Schedule Dental Appointments Daily Exercising Recognizes medication regime Self admin. of medication Understands Basic First Aid/Universal Precautions Maintains Judicial Appointments Understands Fire Evacuation Plan Understands Safe Smoking Recognizes Safe Use of Electrical Equipment Contact the Landlord Avoiding conflicts Rejecting Substance Abuse Understands Safe Sex Practices, Uses Seat Belts
Interpersonal Skills*
Makes Social Plans, Identifies Boundaries, Identifies Coping Skills
Budgeting*
Prioritizing Bills, Paying Bills Saving Money Maintaining a checkbook Contacting Entitlements
Leisure Activities*
Selecting Activities, Playing games Shopping, Pet Care, Use of Natural Supports, Outings Reading, Hobbies/Sports
Transportation*
Assist with public transportation
Was the medication cued or prompted during the shift? If “Other” is selected, please include a brief explanation in the shift notes specifying the reason or circumstances.

YesNoOther
Today's Goal(s):*
Comments:*
Please write the task I.D # (‘s) that you have completed for your shift:*
Staff Initials*
Recovery Assistant Signature*

Clear
Should be Empty:

ABH/Mental Health Daily Shift Progress Report

Level of Assistance (LOA) Definitions: