Procedural Support Note (Pediatric Music Therapy)

Date/Time of Service: [Date; time of service]

Author/Credentials: [Name, credentials]

Service: Music Therapy

Setting/Location: [Unit/clinic/room]

Patient Communication: [Language; interpreter use and ID if applicable; communication mode]

Procedure Context

• Procedure: [Type] — [Body site/laterality if relevant]
• Status: [completed as planned / delayed / aborted / partially completed]
• MT Support Time: [Start time – Stop time]
• Analgesia/Anxiolysis Context: [Agents/timing and source of information] (Include only if relevant to interpreting distress or coping; attribute as "per chart" or "per RN report" when not directly observed; omit if not applicable.)

Indication & Baseline

[Functional encounter goal in brief behavioral terms]

• Request/Presence: [Who requested support; who was present]
• Pertinent Background: [Prior procedural coping history; relevant sensory/developmental considerations; patient/family music preferences] (Include only items that inform today's approach.)
• Baseline: [Observable affect, engagement, coping readiness] (If unable to assess, document "Unable to assess due to [reason].")

Intervention & Response

[Chronological narrative across pre-, during-, and post-procedure as applicable] (Use brief time-anchors such as "Pre—", "During—", "Post—" or approximate timestamps. Specify music therapy approach and relevant musical elements. Document observable distress and coping behaviors; include direct quotes selectively for preferences or self-reported distress. Attribute inferred states to observed evidence or self-report. Note coordination with nursing/child life and post-procedure return-to-baseline observations.)

Outcome Summary

• Procedure/Coping Outcome: [completed with support / required breaks / multiple attempts / aborted due to distress]
• Change from Baseline: [Concise pre vs during vs post summary]
• What Helped: [Effective strategies/interventions]
• What Did Not Help: [Ineffective or declined approaches] (Omit if not applicable.)
• Caregiver/Staff Observations: [Notable comments] (Include only if offered.)

Plan & Handoff

• Handoff/Updates: [Who was updated; key information communicated]
• Recommendations for Future Procedures: [Preferred music/content; pacing; positioning; environmental modifications; caregiver/staff roles; what to avoid] (Keep actionable and concise.)
• Next MT Involvement: [As needed / Next planned visit / Trigger for consult]

(Omit elements that do not apply. When clinically significant information is missing, document "Unable to assess due to [reason]" rather than leaving blank. If late or corrected entry, note per institutional policy.)

Electronic Signature: [Name, Credentials, Date/Time]