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Group Therapy Template

1. Date of group:

2. Patient Initials:

3. Start time: End Time:

4. CPT Code:

5. Group name:

6. Number of attendees:

7. Number of those who did not attend:

8. Number of those leading the group:

9. Behaviors observed in the group:

10. Observations of members in the group:

11. Stressors/extraordinary events/new issues presented during group:

12. Goals/objectives addressed during the group

13. Strategies to Achieve Goals(Explanation of services provided)

14. Responses of members to group interventions, be specific.

· Describe how the session has helped move the group closer to, further away from, or had no discernible impact on meeting goals/objectives. If no progress is made over time, this section should address how the group leader intends to change his/her strategy.

15. Suicidal ideas or Intentions Suicidal Ideations observed by group?

16. Person response to interventions and progress toward goals and objectives during group

17. Appearance and Behavior:

18. Suicidal Ideations observed by patient

Future Plan/additional information:

No APA format needed

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