Progress Note – WM RES Daily Note
Client:
InSyst #	Last Name	First Name
Service Date:	Procedure Code:	372 3.2 WM Residential WithdrMgmt	EOD:
Services were provided in:	by ☐ interpreter or ☐ clinician	Total Time (no doc. time):
Agency:	Cherry Hill Detox (WM)	RU:
Location:	Residential Substance Abuse Treatment Facility
Instructions and Pre-Existing Diagnoses
When writing progress notes, respond to problems/goals/objectives of treatment plan and signs and symptoms related to diagnosis. Include treatment interventions and address changes in the client’s functioning. If there is little progress, include an explanation of the limited progress. Reminder: Providers are required to establish and maintain a sign-in sheet for every group counseling session, independent from CG. Sign-in sheet shall contain: 1) legibly printed counselor/therapist name & signature who conducts the session; 2) start & end time of group session; 3) date of group session 4) topic of session; and, 5) client legibly printed name and signature. For Case Management or Physician Consultation claiming, a separate single service note must used.
Daily Service 1 – Components of WM Services ONLY
Topic/Purpose:	Location:
Service Type:	SUD Counselor/LPHA:
Start Time:	End Time:	Duration:
Description of Service:
Daily Service 2 – Components of WM Services ONLY
Topic/Purpose:	Location:
Service Type:	SUD Counselor/LPHA:
Start Time:	End Time:	Duration:
Description of Service:
Daily Service 3 – Components of WM Services ONLY
Topic/Purpose:	Location:
Service Type:	SUD Counselor/LPHA:
Start Time:	End Time:	Duration:
Description of Service:
Daily Service 4 – Components of WM Services ONLY
Topic/Purpose:	Location:
Service Type:	SUD Counselor/LPHA:
Start Time:	End Time:	Duration:
Description of Service:
Daily Service 5 – Components of WM Services ONLY
Topic/Purpose:	Location:
Service Type:	SUD Counselor/LPHA:
Start Time:	End Time:	Duration:
Description of Service:
Additional Service Information (add information or description of activities if needed)
Progress Note Documentation Time
Date:	Start:	End:	Total Doc. Time:
Documentation Log (Use when documenting time completing clinical forms. Do not include this time above)
Start:	End:	Time:	Type:
Start:	End:	Time:	Type:
Start:	End:	Time:	Type:
Start:	End:	Time:	Type:
Start:	End:	Time:	Type:
Signature of SUD Counselor/LPHA	Printed Name/Credential	Date