You are on page 1of 2

313

Format for a psychotherapy note

(On your letterhead and perhaps an unusually colored paper)

Page number

Psychotherapy Note
_______

Name of client ___________________________

Case/ID number _______________

NOTICE:
This page is a Psychotherapy Note under the HIPAA regulations. It must not be included in or
attached to any other part of the clients health care records except other Psychotherapy Notes. Patients do
not have access to these notes and releasing them requires a special Authorization.
Date
Codes*
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
________________________________________________________________________
Reminder: Sign and date every entry.
Codes

You might also like