Achievement Behavior Care
BCBA Session NOTES
Session Type
*
Direct Supervision
Parent Training
Treatment Planning
Assessment
PLEASE SUBMIT SEPARATE NOTE for: Direct Supervision, Parent Training, or Treatment Planning
Session Information
BCBA's Supervisor Name
*
First Name
Last Name
Authorized Billing BCBA
First Name
Last Name
Paraprofessional's Name
*
First Name
Last Name
Client's Name
*
First Name
Last Name
Client's DOB
*
-
Month
-
Day
Year
Date
Session Date
*
-
Month
-
Day
Year
Date
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
:
Hour
00
05
10
15
20
25
30
35
40
45
50
55
Minutes
Duration
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
05
10
15
20
25
30
35
40
45
50
55
Minutes
AM
PM
AM/PM Option
Until
until
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
05
10
15
20
25
30
35
40
45
50
55
Minutes
AM
PM
AM/PM Option
Location
*
Client's Home
Client's Community
BCBA Office (H codes only)
Notes
why did session occur?
0/60
BCBA's Signature
*
Signature Para (supervision)
*
Signature Provided by
*
Therapist
Parent
BCBA
Please indicate who provides the signature above
Service Code (office only)
H0031
H0032
H2014
Other
Submit
Should be Empty: