Session Info

Date:

CPT / E&M code:

Session duration (min):

Modality (in-person / telehealth / phone):

Attendance (client / parent / collateral / interpreter):

CBT Work

Agenda, mood check, homework review, target situation, automatic thoughts, emotions, behaviors, and cognitive distortions.

Interventions: Socratic questioning, evidence review, behavioral experiment, exposure, problem solving, or skills rehearsal.

Homework

New practice assignment, anticipated barriers, confidence rating, and measurement plan.

0/27 Score

0 of 9 Answered

minimal 0-4 minimal · 5-9 mild · 10-14 moderate · 15-19 mod-severe · 20-27 severe

Little Interest or Pleasure in Doing Things

0123

Unanswered

Feeling Down, Depressed, or Hopeless

0123

Unanswered

Trouble Falling/Staying Asleep, or Sleeping Too Much

0123

Unanswered

Feeling Tired or Having Little Energy

0123

Unanswered

Poor Appetite or Overeating

0123

Unanswered

Feeling Bad About Yourself — or That You Are a Failure

0123

Unanswered

Trouble Concentrating on Things

0123

Unanswered

Moving or Speaking Slowly, or Restless/Fidgety

0123

Unanswered

Thoughts of Being Better off Dead or Hurting Yourself

0123

Unanswered

Variant: adult
Item Responses

Not Provided/21 Score

Feeling Nervous, Anxious, or on Edge

0123

Unanswered

Not Being Able to Stop or Control Worrying

0123

Unanswered

Worrying Too Much About Different Things

0123

Unanswered

Trouble Relaxing

0123

Unanswered

Being So Restless That It Is Hard to Sit Still

0123

Unanswered

Becoming Easily Annoyed or Irritable

0123

Unanswered

Feeling Afraid as if Something Awful Might Happen

0123

Unanswered

CBT Session Targets

Homework review (last session):

Cognitive distortion(s) identified:

Belief rating before (0-100%):

Belief rating after (0-100%):

SUDS before (0-100):

SUDS after (0-100):

New homework:

Risk / safety review (PHQ-9 item 9, ideation check).

Plan and Follow-Up

Focus	Documentation
Target	Name the target situation, belief, behavior, value, skill deficit, or exposure item addressed. Target: Baseline rating / context: Patient goal:
Work completed	Record intervention steps, patient response, learning, barriers, and safety considerations. In-session work: Response / learning: Barriers / safety:
Practice plan	Specify homework, frequency, supports, measurement, and next session focus. Home practice: Measurement / review: Next focus:

Focus

Documentation

Target

Name the target situation, belief, behavior, value, skill deficit, or exposure item addressed.

Target:

Baseline rating / context:

Patient goal:

Work completed

Record intervention steps, patient response, learning, barriers, and safety considerations.

In-session work:

Response / learning:

Barriers / safety:

Practice plan

Specify homework, frequency, supports, measurement, and next session focus.

Home practice:

Measurement / review:

Next focus:

Session Info

CBT Work

Homework

PHQ-9

Over the past 2 weeks, how often have you been bothered by...

GAD-7

Details

Responses

CBT Session Targets

Plan and Follow-Up

Counseling - CBT Session Note

Preview