Case Management Progress Note

Document case management contacts, interventions, and resident progress.

Kura Solution

Appendix P — Case Management Progress Note

Document case management contacts, interventions, and resident progress.

Header

Resident Name *

Date of Service *

Duration (minutes)

Service

Service Type

AssessmentCare CoordinationSkill-BuildingCrisis InterventionAdvocacyDischarge PlanningOther

If Other, specify

Location of Service

On-siteCommunityPhone / Telehealth

Note

Goal Addressed (from Recovery Plan)

Intervention Provided

Resident Response / Progress

Barriers Identified

Plan / Next Steps

Signatures

Case Manager Signature *

Sign here

Use mouse, trackpad, or finger to sign.

Case Manager Printed Name *

Date *

Supervisor (if required) Signature *

Sign here

Use mouse, trackpad, or finger to sign.

Supervisor (if required) Printed Name *

Date *

Electronic Signature ConsentI agree that the signature(s) I have provided above are my legal electronic signatures, with the same effect as a handwritten signature, under the federal E-SIGN Act (15 U.S.C. § 7001 et seq.) and applicable state law (UETA). I authorize Kura Solution to maintain this signed form as a legal record. I have had the opportunity to read and understand this form and my signature(s) are made knowingly and voluntarily.

A signed PDF copy will download to your device after submission. Records protected under 42 CFR Part 2 & HIPAA.

Kura Solution

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