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Medicaid State Plan Amendment (09-61) – Session Notes (handout #3)

Session notes must include:

Student’s name

Specific type of service provided

Whether the service was provided individually or in a group (specify the actual group size)

The setting in which the service was rendered (school, clinic, other)

Date and time the service was rendered (length of session –  record session start time and end time)

Brief description of the student’s progress made by receiving the service during the session

Name, title, signature and credentials of the person furnishing the service and signature/credentials of supervising clinician as appropriate

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