Clinical Notation: Documentation for clients in treatment - CASAT
Clinical Notation: Documentation for clients in treatment - CASAT
Clinical Notation: Documentation for clients in treatment - CASAT
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Sample of Progress Notes-TopicsExamples of TOPICS section of the Progress Notes.Met with Curt <strong>for</strong> 60 m<strong>in</strong>s. Discussed alcohol abst<strong>in</strong>ence. Began address<strong>in</strong>galternative ways he might deal with his physical pa<strong>in</strong> and also enjoyleisure/relaxation without dr<strong>in</strong>k<strong>in</strong>g. Driv. Dims. 2, 3, 5.ASAM 2, 3, and 6. Court trial on 4/16, allergies, relationship with father,substance abuse.Met with Garlen <strong>for</strong> 50 m<strong>in</strong>s. Discussed problems with his impulsivity andreactions to certa<strong>in</strong> th<strong>in</strong>gs. Addressed self control and th<strong>in</strong>k<strong>in</strong>g errors. Driv.Dims. 3, 6.Met with Eric <strong>for</strong> 50 m<strong>in</strong>s. Discussed stress related to work, school, and legalresponsibilities. Addressed how he is manag<strong>in</strong>g while prevent<strong>in</strong>g relapse.Driv. Dims. 3, 5,
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