Psychological/Neuropsychological Assessment Feedback Session Note

Date of Service: [Date] (If unknown, enter "not captured.")

Author/Credentials: [Author name, degree(s), license] (If unknown, enter "not captured.")

Setting: [Clinic/Department/Location] (If unknown, enter "not captured.")

Modality: [in-person / video / audio-only]

Duration: [Total minutes] (If unknown, enter "not captured.")

Attendees: [All persons present with relationship to patient] (If only the patient attended, enter "patient only." Never omit this field.)

Consent/Authorization Basis: [Patient consent for caregiver participation / legal authority such as guardian or POA / rationale if feedback provided without patient present] (If unknown, enter "not captured.")

Assessment Reference: [Assessment type(s), testing dates, report status and location in chart, original referral question] (Reference the full report for technical details.)

Session Overview

[Session purpose and agenda, including that results, diagnostic impressions, functional implications, and recommendations were reviewed] (Include any patient/caregiver priorities for the session. Note interval updates since testing only if clinically relevant. Include mental status observations only if they affected the patient's ability to receive feedback or participate in planning.)

Feedback Delivered

(Summarize what was explained in everyday language first, then clinical terms. Do not reproduce raw test scores, test items, or copyrighted materials. Write assuming the patient may read this note.)

• Cognitive findings: [Strengths and challenges in everyday terms, with clinical domains as appropriate and functional examples]
• Emotional/behavioral findings: [Patterns observed with functional implications]
• Diagnostic impressions reviewed: [DSM/ICD diagnoses or clinical impressions discussed with brief rationale]
• Validity considerations: [Any factors limiting interpretation, described neutrally] (Omit if none.)
• Questions addressed: [Key questions asked and answers provided, including any misunderstandings corrected] (Omit if none.)

Recommendations

(Document all recommendations discussed. Lead with any safety-critical items. For each, note who is responsible and timeframe. If declined, document what was offered, stated reason, alternatives discussed, and return precautions.)

• [Safety-critical recommendations if applicable: driving restrictions, medication supervision, means safety, crisis resources]
• [Clinical referrals and treatment recommendations]
• [Functional supports and accommodations]
• [Follow-up testing interval if indicated]
• [Declined recommendations with reason, alternatives offered, and return precautions] (Omit if none declined.)

Patient/Caregiver Response & Plan

• Emotional response: [Observed or reported reactions to feedback]
• Understanding demonstrated: [What patient/caregiver accurately restated in their own words about findings, diagnoses, and next steps] (Note any remaining misunderstandings.)
• Decisions made: [Referrals accepted or declined, safety steps agreed to, who will schedule what]
• Care coordination: [Report shared with providers, accommodation letters provided, releases obtained] (Omit if none.)
• Follow-up: [Next appointments scheduled or timeframe for check-in, return precautions for symptom worsening or safety concerns]