PROPOSED FORM - For Review
CASEWORKER / CARE MANAGER PROGRESS NOTES
Section 11: Caseworker Notes
Member Name:
Date of Birth:
MassHealth ID:
Date of Visit/Contact:
Time:
Caseworker Name:
Visit/Contact Type:
Home Visit
Office Visit
Phone Call
Care Coordination
MDT Meeting
Other: ________
PURPOSE OF VISIT/CONTACT
Monthly Check-in
Semi-Annual Review
Annual Review
Home Assessment
Safety Check
Caregiver Log Review
Incident Follow-up
Care Plan Review
Service Coordination
Problem Resolution
Fire Drill
Other: ________________
PROGRESS NOTES (SOAP Format Recommended)
S
- Subjective (Member/Caregiver report):
O
- Objective (Observations, data):
A
- Assessment (Analysis, concerns):
P
- Plan (Next steps, follow-up):
MEMBER STATUS
Overall Condition:
Stable
Improved
Declined
Significant Change
Setting Suitability:
Appropriate
Concerns Noted
Requires Review
Caregiver Status:
Adequate
Needs Support
Concerns Noted
FOLLOW-UP REQUIRED
Next Visit Date:
Next Visit Type:
Action Items:
Caseworker Signature
Date
Supervisor Review (if required)
Date