Outcome Measures/Progress Report (Dance/Movement Therapy)

Report Date: [report date]

Reporting Period: [start date] – [end date]

Patient: [full name, DOB, MRN]

Author: [name, credentials, license number if applicable, organization]

Service Setting: [outpatient clinic / school-based / inpatient / home / telehealth]

(If sharing externally with payers or referral sources, include one sentence confirming patient authorization for release and that this document reflects clinical record content rather than psychotherapy process notes.)

Service Overview

[Purpose of this report: re-authorization, care coordination, IEP support, discharge planning, or other]. [Primary diagnosis or presenting condition]. [Service format: individual / group] via [in-person / telehealth]. [Dosage during reporting period: sessions completed, planned frequency, typical session length, attendance notes]. [Relevant safety precautions or accommodations such as fall risk, dissociation triggers, mobility aids, or sensory supports] (Only include if pertinent to reader understanding or care coordination.)

Outcome Measures & Goal Progress

Measures: [For each instrument or measurement approach used, state the tool name, domain measured, baseline score with date, current score with date, direction and magnitude of change, and brief clinical interpretation. If standardized tools were not used, describe the alternative approach with clear operational definitions. If a planned measure was not obtained, state the reason.]

Goal Progress: [For each active treatment goal, state the goal in observable terms, its current status (met / partially met / not met / on hold / discontinued), and the evidence supporting that rating including relevant outcome scores, observed functional indicators, or structured patient report. Note any goals modified, added, or discontinued this period with brief rationale.] (Convert vague goals to observable indicators such as frequency, duration, participation level, distress tolerance behaviors, or recovery time.)

Functional Summary

[Concise narrative (3–5 sentences) describing observed functional and psychosocial changes during the reporting period across relevant domains such as affect regulation, interpersonal engagement, body awareness, coping skill use, ADL or school/work participation, mobility and coordination.] (Tie each stated change to at least one supporting data point from measures, session-based counts, or documented observations. Avoid detailed session content, verbatim dialogue, or psychotherapy process material.)

Clinical Impression & Plan

[Synthesis (2–3 sentences) interpreting outcome data, noting whether progress aligns with expected trajectory, the confidence level in this assessment based on data completeness, and key barriers or facilitators.]

Recommendation: [continue current plan / modify plan / discharge] with [clinical rationale].

Proposed frequency and duration: [frequency, session length, and duration for next interval].

Updated or new goals: [summary of goal changes] (Only include if applicable.)

Care coordination actions: [referrals, team communication, collateral contacts] (Only include if applicable.)

Home practice: [high-level recommendations] (Only include if used.)

Next reassessment: [date and planned measures or approach].

Signature

Electronic Signature: [name, credentials]

Date: [signature date]

Co-signature: [supervisor name, credentials, date] (Only include if required by setting, payer, or licensure.)