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Youth Stats Sheet

Daily Totals Day


1
Day
2
Day
3
Day
4
Day
5
Day
6
Day
7
Day
8
Day
9
Day
10
Day
11
Day
12
Day
13
Day
14
Total
Rec Outings
In House Activities


Group
Programing


Family Support/
Counselling


Client Related
Travel



Counselling

Counselling/Support


Referrals



Discharge
Planning/ICM



Grand Total for Counselling Section





Youth Name: SYD File Number:
Admission Date: Discharge Date:
Case Manager: Staff Completing Form:

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