Session Note for Tricare

Authorized ABA Supervisor *

Rendering Provider Name

Beneficiary Full Name *

DOD Benefit Number (DBN)

Date of Session *

Start Time *

Stop Time *

Length of Session (minutes) *

Location of Rendered Services *

Full Names of all session participants *

CPT Code for session

Beneficiary's current clinical status evidenced by the beneficiary's signs and symptoms

Narrative content of session

Summarize the techniques attempted during the session

Positive Reinforcement

Shaping

Chaining

Task Analysis

FCT

Visual Schedules

Activity Schedules

Self-monitoring

Video Modeling

Extinction

Pairing

Mand Training

Verbal Behavior

PECS

AAC

Premack Principle

Behavior Momentum

Behavior skills training

Describe the response to the treatment (include outcome of the treatment and response to significant others)

Summarize beneficiary's degree of progress towards the treatment goals

Rendering Provider full name

Provider type/level

Rendering provider signature and date

Clear

If you are human, leave this field blank.

BBH ABA Therapy

Providing the Columbia, SC area with quality, evidence based ABA therapy.

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Copyright 2022 Bardin Behavioral Health, LLC - All photographs used on this webpage are stock photographs that have been purchased or photographs used with the written permission of the owner. None of the individuals depicted are recipients of services provided by Bardin Behavioral Health, LLC.

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