Peer Recovery Support Encounter/Care Coordination Note

Date: [Date]

Start/End Time: [Start time] – [End time]

Duration: [Minutes]

Modality: [in-person / phone / video / text-based]

Location Type: [clinic / community / shelter / home / hospital / other]

Encounter Type: [direct participant contact / collateral contact / outreach attempt (no contact) / coordination-only]

Participants Present: [Participant and others with relationship noted]

Peer Worker: [Name, credential or title, organization]

Consent/ROI Note: [Authorization statement describing who authorized disclosure, what information was shared, and with whom] (Only include if coordination with external entities occurred.)

Reason for Contact

[Reason for today's contact and the participant's stated priority] (One to three sentences explaining context such as scheduled follow-up, post-discharge engagement, participant request, or outreach after missed appointment. Include a brief direct quote if it captures motivation or ambivalence.)

Goals & Interventions

(Link goals to the participant's recovery plan when available. Use the participant's language for goals. If no plan of care is accessible, note that goals were set collaboratively today.)

• [Goal 1 in participant's words]

  • [Progress observed this encounter]
  • [Barriers encountered] (Use "not assessed" if not discussed.)

• [Goal 2 in participant's words] (Include additional goals only if addressed.)

  • [Progress observed this encounter]
  • [Barriers encountered]

Peer support interventions provided:

• [Intervention and brief description of what resulted] (Use action verbs: rapport-building, motivational engagement, recovery coaching, resource navigation, accompaniment, skills coaching, benefits assistance, appointment preparation, advocacy. Frame as peer support, not clinical treatment.)
• [Additional intervention as needed]

Care Coordination Actions

(Document each action in a trackable format. Do not document completion without verification.)

• Target service or resource: [Service or resource name]

  Action taken: [scheduled / called / warm handoff / accompanied / referral submitted / information provided / other]

  Result: [appointment scheduled with date, time, location / referral pending / unable to reach with attempt count / declined by participant]

  Follow-up owner: [peer / participant / provider] — [Due date]

  Verification: [participant report / provider confirmation / EHR / pending verification]

• (Add additional coordination actions as separate list items.)

Safety / Crisis Support

(Include only if immediate safety concerns arose such as suicidal ideation, overdose risk, acute withdrawal, or domestic violence. Omit entirely when no safety concerns were present.)

• Prompt for concern: [What was said or observed that raised concern]
• Actions taken: [crisis line / mobile crisis / supervisor notification / emergency services / other steps within peer scope]
• Participant response: [Consent or decline; describe involvement and preferences]
• Disposition: [Outcome, handoff details, and who remains responsible]

Plan / Next Steps

• Participant next steps: [One to three participant-chosen items]
• Peer next steps: [Specific tasks with due dates]
• Care team tasks: [Tasks for other team members if applicable]
• Next planned contact: [Date or timeframe], [modality], [purpose]

Outreach Attempt (No Contact)

(Use only when Encounter Type is outreach attempt with no contact. Replace Goals & Interventions and Care Coordination Actions with this section.)

• Attempt method(s) and time(s): [call / text / in-person visit] — [timestamps]
• Message left: [yes / no] — [brief content summary if yes]
• Safety check actions: [Actions taken if high-risk and unreachable, or not applicable]
• Next attempt plan: [When and how next outreach will occur]