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  • FAP Session Note, Template

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    http://earlyintervention-dots.blogspot.com/
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    This document is a session note from a NYC Early Intervention Program. It documents a therapy session for a child, including the interventionist's name and credentials, date and time of the session, IFSP outcomes addressed, progress made by the child and family, and activities during the session. The note also documents the parent/caregiver involvement, including any activities done together or reviewed with the parent, as well as the planned activities for next week.

    Original Description:

    Personal Touch EIP Session Note template Revised 5/2008

    Original Title

    FAP Session Note, template

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    This document is a session note from a NYC Early Intervention Program. It documents a therapy session for a child, including the interventionist's name and credentials, date and time of the session, IFSP outcomes addressed, progress made by the child and family, and activities during the session. The note also documents the parent/caregiver involvement, including any activities done together or reviewed with the parent, as well as the planned activities for next week.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    816 views1 page

    FAP Session Note, Template

    Uploaded by

    http://earlyintervention-dots.blogspot.com/
    This document is a session note from a NYC Early Intervention Program. It documents a therapy session for a child, including the interventionist's name and credentials, date and time of the session, IFSP outcomes addressed, progress made by the child and family, and activities during the session. The note also documents the parent/caregiver involvement, including any activities done together or reviewed with the parent, as well as the planned activities for next week.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    NYC EARLY INTERVENTION PROGRAM Personal-Touch EIP SESSION NOTE

    Child’s Name: ______________________________________________________ DOB: ____/____/____ EI #:_______________________


    (Last) (First)

    Interventionist’s Name: _________________________________________ Discipline: __________ Location of Service:______________

    TEAM COLLABORATION: Document communication with other team members regarding the child’s services and progress via: phone, in
    person or in the notebook, use back of note if needed: ___________________________________________________________________
    ____________________________________________________________________________________________ Date: ____/____/____
    BOROUGH: Queens (120) Brooklyn (126) Bronx/Manhattan (125)

    Date: _____/_____/_____ Time: From_________ To __________ Service Type: __________ Date note written: _____/_____/_____
    IFSP OUTCOME(S) ADDRESSED: ‰ Make-up session for: ____/____/____

    PROGRESS BY CHILD/FAMILY RELATED TO OUTCOMES:

    ‰ Worked with parent/care giver and child together ‰ Worked with parent/care giver alone ‰ Worked with child alone
    ACTIVITY DURING SESSION:

    ACTIVITY WITH PARENT/CAREGIVER (check all that apply) ‰ Therapist used alternate tool to work with parent/caregiver
    ‰ Discussed session activity with parent/caregiver (e.g., phone call, notebook)
    ‰ Showed parent/caregiver activity ‰ Parent/caregiver unavailable
    ‰ Parent/caregiver tried activity, therapist assisted
    ‰ Reviewed Calendar with parent

    List Family Plan/Calendar activity for next week:


    ACTIVITY SHOULD IDENTIFY WHO,
    WHAT, WHEN, AND WHERE.

    Parent/Caregiver Signature: __________________________________ __ Relationship to child: _____________________________


    *Parent/Caregiver should not sign a blank session note.

    Interventionist Signature: ________________________________________________________Credentials: _____________________

    Date: _____ /_______/______ Time: From_________ To__________ Service Type: ________ Date note written: ______/______/______
    IFSP OUTCOME(S) ADDRESSED: ‰ Make-up session for: ____/____/____

    PROGRESS BY CHILD/FAMILY RELATED TO OUTCOMES:

    ‰ Worked with parent/care giver and child together ‰ Worked with parent/care giver alone ‰ Worked with child alone
    ACTIVITY DURING SESSION:

    ACTIVITY WITH PARENT/CAREGIVER (check all that apply)


    ‰ Therapist used alternate tool to work with parent/caregiver
    ‰ Discussed session activity with parent/caregiver (e.g., phone call, notebook)
    ‰ Showed parent/caregiver activity ‰ Parent/caregiver unavailable
    ‰ Parent/caregiver tried activity, therapist assisted
    ‰ Reviewed Calendar with parent
    List Family Plan/Calendar activity for next week:
    ACTIVITY SHOULD IDENTIFY WHO,
    WHAT, WHEN, AND WHERE.
    Parent/Caregiver Signature: __________________________________ __ Relationship to child:_____________________________
    *Parent/Caregiver should not sign a blank session note.
    Interventionist Signature:_________________________________________________________Credentials:_____________________
    EIP-15 (Rev. 5/06) P/T (Rev 5/08)

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