Counseling Progress Note_Tx Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Counselor/Therapist NameClient DemographicsClient NameFirstLastSession Date/TimeDateTimeSession Type/FormatIn-personTelehealth (video)PhoneGroupDuration of Session (mins.) Selected Value: 55 Primary DiagnosisAttention-Deficit/Hyperactivity Disorder (ADHD), Predominantly Inattentive PresentationAttention-Deficit/Hyperactivity Disorder (ADHD), Predominantly Hyperactive/Impulsive PresentationAttention-Deficit/Hyperactivity Disorder (ADHD), Combined PresentationAutism Spectrum DisorderIntellectual Disability (Intellectual Developmental Disorder)SchizophreniaSchizoaffective DisorderDelusional DisorderBrief Psychotic DisorderBipolar I DisorderBipolar II DisorderCyclothymic DisorderMajor Depressive Disorder, Single EpisodeMajor Depressive Disorder, RecurrentPersistent Depressive Disorder (Dysthymia)Disruptive Mood Dysregulation DisorderPremenstrual Dysphoric DisorderGeneralized Anxiety DisorderPanic DisorderSocial Anxiety Disorder (Social Phobia)Specific PhobiaAgoraphobiaSeparation Anxiety DisorderObsessive-Compulsive DisorderBody Dysmorphic DisorderHoarding DisorderTrichotillomania (Hair-Pulling Disorder)Excoriation (Skin-Picking) DisorderPosttraumatic Stress Disorder (PTSD)Acute Stress DisorderAdjustment Disorder, With Depressed MoodAdjustment Disorder, With AnxietyAdjustment Disorder, With Mixed Anxiety and Depressed MoodAdjustment Disorder, With Disturbance of ConductAdjustment Disorder, With Mixed Disturbance of Emotions and ConductAdjustment Disorder, UnspecifiedProlonged Grief DisorderDissociative Identity DisorderDissociative AmnesiaDepersonalization/Derealization DisorderSomatic Symptom DisorderIllness Anxiety DisorderFunctional Neurological Symptom Disorder (Conversion Disorder)Anorexia NervosaBulimia NervosaBinge-Eating DisorderAvoidant/Restrictive Food Intake Disorder (ARFID)Insomnia DisorderNarcolepsyGender Dysphoria in Adolescents and AdultsOppositional Defiant DisorderIntermittent Explosive DisorderConduct DisorderAntisocial Personality DisorderAvoidant Personality DisorderBorderline Personality DisorderDependent Personality DisorderHistrionic Personality DisorderNarcissistic Personality DisorderObsessive-Compulsive Personality DisorderParanoid Personality DisorderSchizoid Personality DisorderSchizotypal Personality DisorderAlcohol Use DisorderCannabis Use DisorderOpioid Use DisorderStimulant Use DisorderSedative, Hypnotic, or Anxiolytic Use DisorderTobacco Use DisorderGambling DisorderOther Specific Mental DisorderUnspecified Mental DisorderSecondary DiagnosisAttention-Deficit/Hyperactivity Disorder (ADHD), Predominantly Inattentive PresentationAttention-Deficit/Hyperactivity Disorder (ADHD), Predominantly Hyperactive/Impulsive PresentationAttention-Deficit/Hyperactivity Disorder (ADHD), Combined PresentationAutism Spectrum DisorderIntellectual Disability (Intellectual Developmental Disorder)SchizophreniaSchizoaffective DisorderDelusional DisorderBrief Psychotic DisorderBipolar I DisorderBipolar II DisorderCyclothymic DisorderMajor Depressive Disorder, Single EpisodeMajor Depressive Disorder, RecurrentPersistent Depressive Disorder (Dysthymia)Disruptive Mood Dysregulation DisorderPremenstrual Dysphoric DisorderGeneralized Anxiety DisorderPanic DisorderSocial Anxiety Disorder (Social Phobia)Specific PhobiaAgoraphobiaSeparation Anxiety DisorderObsessive-Compulsive DisorderBody Dysmorphic DisorderHoarding DisorderTrichotillomania (Hair-Pulling Disorder)Excoriation (Skin-Picking) DisorderPosttraumatic Stress Disorder (PTSD)Acute Stress DisorderAdjustment Disorder, With Depressed MoodAdjustment Disorder, With AnxietyAdjustment Disorder, With Mixed Anxiety and Depressed MoodAdjustment Disorder, With Disturbance of ConductAdjustment Disorder, With Mixed Disturbance of Emotions and ConductAdjustment Disorder, UnspecifiedProlonged Grief DisorderDissociative Identity DisorderDissociative AmnesiaDepersonalization/Derealization DisorderSomatic Symptom DisorderIllness Anxiety DisorderFunctional Neurological Symptom Disorder (Conversion Disorder)Anorexia NervosaBulimia NervosaBinge-Eating DisorderAvoidant/Restrictive Food Intake Disorder (ARFID)Insomnia DisorderNarcolepsyGender Dysphoria in Adolescents and AdultsOppositional Defiant DisorderIntermittent Explosive DisorderConduct DisorderAntisocial Personality DisorderAvoidant Personality DisorderBorderline Personality DisorderDependent Personality DisorderHistrionic Personality DisorderNarcissistic Personality DisorderObsessive-Compulsive Personality DisorderParanoid Personality DisorderSchizoid Personality DisorderSchizotypal Personality DisorderAlcohol Use DisorderCannabis Use DisorderOpioid Use DisorderStimulant Use DisorderSedative, Hypnotic, or Anxiolytic Use DisorderTobacco Use DisorderGambling DisorderOther Specific Mental DisorderUnspecified Mental DisorderCPT CODE90791 — Psychiatric Diagnostic Evaluation | Initial Evaluation90832 — Individual Psychotherapy | 30 minutes90834 — Individual Psychotherapy | 45 minutes90837 — Individual Psychotherapy | 60 minutes90846 — Family Psychotherapy Without Patient Present | 50 minutes90847 — Family/Couples Psychotherapy With Patient Present | 50 minutes90853 — Group Psychotherapy | 60 minutes90839 — Psychotherapy for Crisis | First 60 minutes90840 — Psychotherapy for Crisis, Add-On | Each additional 30 minutes90785 — Interactive Complexity | Add-On CodePresenting Concern / Reason for VisitInterventions Used (what you did in session) / Progress Duration Client Response / Progress This SessionRisk Assessment / Safety (SI/HI, self-harm, safety plan)Plan / Next Steps (homework, goals, follow-up)Other Relevant InformationNext Session / Return DateSpecific Return Date: __________Later This WeekNext WeekIn Two WeeksNext MonthCheck Back InAs NeededTerminationUnknown / To Be DeterminedOtherSpecific Return DateDateTimeTreatment Plan SectionTreatment Plan TypeOriginal Tx Plan6 Month Review/UpdateOtherPrimary Presenting Concern(s)Treatment Plan GoalsObjective #1Objective #2Objective #3Objective #4Treatment Plan Target Date / Review DateSubmit
