Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Treatment planning

  • Turned in by deadline

  • Graphs and data included

  • Meets all criterion set forth in treatment plan template

  • Clinically appropriate hours recommended

  • Correct CPT codes used (based on insurance)

  • Additional documents completed by deadline

  • If applicable, plan uploaded to ABPathfinder

  • Was this a progress report?

  • All base sections updated (history, assessment, schedule of services and discharge/fading)

  • Goals Section

  • Baseline was not removed from goals

  • Updated status listed per goal

Procedures & Data

  • Each goal has clear procedures

  • Number of incomplete goals

  • Notes on any incomplete goals:

  • Data book is set up

  • Probe data is in data book

  • Skill tracking sheets in data book


  • Plan has been shared with parent

  • New client folder has been shared with parent

  • Parent has signed all forms


  • We have reviewed the result of this assessment.

  • Assessor

  • Assessed Staff

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.