From: Phone:
Date:  Report Covers: to
Patient's Name:
Diagnosis:

Level of Care:
Medical
Residential
Day Treatment/IOP
Continuing Care (After Care)
Marital Counseling
Other

Attendance (Day Treatment, IOP, Continuing Care):
Number of Sessions Scheduled
Number of Sessions Attended this Month

Progress:
Patient's Progress Exceeds Expectations
Patient's Progress is Good, Meeting Treatment Plan Objectives
Patient's Progress is Minimal
Patient is Not Participating

General Comments: