Documentation and Reporting

Question 1

Reporting Variables

Answer 1

When caregivers inform you of other variables (illness, relocation, change of medication), contact your supervisor immediately

Question 2

Session Notes

Answer 2

provide you with the opportunity to record all necessary information from a given session

Question 3

What should session notes consist of?

Answer 3

1. How did the session go
2. Did anything out of the ordinary happen?
3. Did you discuss anything with the caregivers?
4. Did the client meet mastery criteria for any goals?
5. Any information or questions for supervisor?

Question 4

Mandatory Reporting

Answer 4

1. Any suspicion of client abuse or neglect (intentional or unintentional)
2. If a client is in danger of hurting himself or others
3. Any suspicion of domestic violence in the home