Speech-Language Pathology Progress Report (10-Visit/30-Day)

Speech-Language Pathology Progress Report (10-Visit/30-Day)

(Use explicit dates in YYYY-MM-DD format. Omit fields not applicable rather than leaving placeholders. If Reporting Period dates are unknown, flag as must-complete before signing. If the report is written late, include an Administrative Note with the expected date, reason for delay, and actions taken.)

Patient Name: [Patient full name]

DOB: [YYYY-MM-DD]

MRN: [Medical record number] (Omit if not used)

Date Written: [YYYY-MM-DD]

Reporting Period: [Start date] to [End date] (Must complete)

Visits This Period: [Completed] of [Planned]

Episode Visits to Date: [Total completed visits in episode]

Referring Provider: [Name, credentials]

Rendering Clinician: [Name, credentials]

Episode Synopsis

[Primary SLP problem area(s) treated this interval; relevant medical diagnosis/etiology; current precautions affecting SLP care; key participation factors] (3–5 lines; concise summary only—this is not a re-evaluation.)

Service Delivery

Planned frequency/duration: [From active plan of care]

Actual frequency/duration: [Delivered this period]

Attendance: [Attendance pattern; cancellations/no-shows if clinically relevant]

Interventions delivered: [High-level summary of treatment approaches used]

(If actual visits differ significantly from plan, document cause and whether plan changes are recommended.)

Objective Data

(Document objective evidence of change since the last report. Include standardized measures when available; otherwise use quantified measures such as % accuracy, cueing/assistance levels, and diet/liquid levels.)

• [Measure name]: Baseline [value, date] → Current [value, date]; [One-line functional interpretation]

(Add or remove measures as appropriate. For dysphagia, include current diet/liquid recommendation using consistent nomenclature and any safety events this period. If no objective measures were obtained, state the reason and plan to obtain measures next interval.)

Goal Progress

(Organize by problem area. Document both best and typical performance when variability is clinically significant. For goals not progressing, include hypothesized cause and modifications made.)

[Problem Area]

• Goal ID & Statement: [LTG/STG identifier and functional, measurable goal]

  Baseline → Current: [Objective data showing change with dates]

  Status: [Met / Progressing / Partially Met / Not Met / Regressed / Discontinued] (If Met, include Date Met.)

  Clinical interpretation: [1–2 lines on why progress is meaningful or limited; barriers/facilitators; modifications made if not progressing]

(Repeat Problem Area section and goal entries as needed.)

Medical Necessity & Plan

Continued skilled need: [Why SLP services remain necessary; risks without skilled care; why discharge is not yet appropriate—tie to unmet goals]

Plan for next interval: [Continue / Modify / Discharge recommendation]; [Frequency/duration]; [Planned interventions]; [Home program updates]; [Referrals/coordination needed]

Goal revisions: [New/updated goals with identifiers and reason for revision] (Include only when goals are revised or added.)

(If continuing after plateau or regression, explicitly document what occurred, why therapy continues, and what will be different.)

Administrative Note: [Expected report date; reason for delay; actions taken] (Include only if report is written late.)

Clinician Signature: [Electronic or written signature]

Credentials: [Degree, certification]

Date/Time Signed: [YYYY-MM-DD HH:MM]