Personal Care Assistant Daily Encounter Log by 1MwuM7d

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									                                                                 Personal Care Assistant Daily Log 2012 -
                                                                                                   2013

   Early Intervention             School Age                                                                               Sheet:                           of:
Student Information
LEA Name
(School District,                                                                                                   Date
IU, etc.)
                                                                                                                    PA
Student Name                                                                                                        Secure
                                                                                                                    ID

Provider Information
PCA:                                                                       Signature:
PCA:                                                                       Signature:
PCA:                                                                       Signature:

                                                                                                                                                            Progress     PCA
                                                                                                                                    Service     Treatment
Time In    Time Out                     Description of Service (daily notes on activity, location, and outcome)                      Type          Key
                                                                                                                                                            Indicator   Initials
                                                                                                                                                               Key




                                                                                          R



Service Type:                                                                                  Progress Indicator Key:
C = Collateral                      D = Direct                 DM = Direct Session:            CS= Collateral Service Mn= Maintaining              Pr= Progressing
MS = Monthly Summary                PA = Provider Absent        Make-up Session
                                                                                               Ev= Evaluation          Ms= Mastering               Rg= Regressing
PNA = Provider Not Available        SA = Student Absent        SNA = Student Not               In= Inconsistent
                                                               Available
Supervisor’s                                                          Supervisor’s
                                                                                                                                              Date:
Name:                                                                 Signature:




 Public Consulting Group       http://www.publicconsultinggroup.com/client/paaccess/           SBAPsupport@pcgus.com                            (866) 912-2976
                                                               Personal Care Assistant Daily Log 2012 -
                                                                                                 2013
Treatment Key:


1                Direct               Assisting the student to use equipment
2                Direct               Assisting the student to use and maintain augmentative communication devices
3                Direct               Assisting the student to ambulate, position, and transfer
4                Direct               Range of motion and other exercises
5                Direct               Activities of daily living such as eating, grooming, bathing, toileting, etc.
6                Direct               Monitoring the incidence and prevalence of designated health problems or medical
                                      conditions, e.g., seizure precautions or extreme lethargy
7                Direct               Hands-on assistance, cueing, or supervision of medical/mental health-related services
                                      provided by the PCA under the direct (on-site) supervision of the professional nurse.
                                      Activities may include catheterizations, suctioning, oxygen admin, and tube feedings.
8                Direct               Observing and intervening to redirect inappropriate behavior
9                Direct               Assisting, monitoring, and guiding the student to pay attention, participate in
                                      activities, and complete tasks
10               Direct               Accompanying students on school buses or other vehicles A PCA’s presence is
                                      necessary because of a student’s physical disability or mental health disability
11               Collateral           Material Preparation
12               Collateral           Professional Responsibilities: Classroom Observation
13               Collateral           Report Writing
14               Collateral           Travel
15               Collateral           Consultation with a medical professional
16               Collateral           Consulting with other SBAP service providers, teachers, and the family concerning the
                                      student’s medical/mental health status and any perceived problems
17               Collateral           Professional Responsibilities: Parent Consultation
18               Collateral           Professional Responsibilities: Teacher / Staff Consultation
19               Collateral           Consulting with other SBAP service providers concerning the student’s
                                      medical/mental health status and any perceived problems
20               Collateral           Consulting with teachers concerning the student’s medical/mental health status and
                                      any perceived problems
21               Collateral           Consulting with the family concerning the student’s medical/mental health status and
                                      any perceived problems




    Public Consulting Group   http://www.publicconsultinggroup.com/client/paaccess/   SBAPsupport@pcgus.com   (866) 912-2976

								
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