BIRP Note Template

• Patient Name

• Therapist/Counselor Name

• Session Date

  Date

• Session Number

• Setting

Behavior

• Subjective Data

• Objective Data

• Client Presentation

• Clinical Symptoms and Severities

Interventions

• Therapeutic Techniques

• Rationale for Intervention

• Client Collaboration

Response

• Client's Response to Intervention

Plan

• Homework

• Will there be a next session?

  Yes

  No

• Next Session Date and Time

  Date

• Goals for Next Session

Additional Considerations

• Confidentiality

  Compliant

  Non-Compliant

  N/A

• Ethical Considerations

• Cultural Considerations

Sign-Off

• Name and Signature of Therapist/Counselor

  Sign