Information
Released to 3rd Party Payer Under HIPPA
nScreening/Assessment
nSymptoms: (DSM glossary of terms)
nResults of clinical tests: (Standardized
questionnaires/tests)
nDiagnosis: DSM , &/or Reason for coming
nTx Plan
nSession start & stop times: (log of
appointments)
nFrequency of Tx: times per week , month and
duration
nModality: (individual, group, couples, family, phone,
etc..)
nTx Activity: (process, techniques, etc..)
nMedical prescription & monitoring: (Rx, evaluations,
re-evaluations)
nProgress: routine, nominal improvement
nPrognosis: (Poor, fair, good, excellent, guarded)