Early Intervention	School Age	Page 1 of 2
School Name:
Student’s Name:	Date of Birth:	PA Secure ID	Service month/year:
Provider’s Name:	Title:	Provider’s Signature:	Date:
Diagnosis/Symptoms:

Service	Treatment	Progress (Refer to keys below and on page 2 for an explanation on progress indicators and treatment codes)
Date	Start Time	End Time	Total Time	Service Type	Treatment key	Individual or Group	Progress Indicator Key	Daily Progress Note

Service Type
Progress Indicator Key
D- Direct Session

DM- Direct Session: Make-up Session
MN- Maintaining

RG- Regressing

PR- Progressing	MS- Mastering

IN- Inconsistent

Supervisor’s Name:
Supervisor’s Signature:
Date:

Treatment Key:	Page 2 of 2

1	Direct	Articulation: Discrimination	26	Direct	Phonological Awareness
2	Direct	Articulation: Oral Motor	27	Direct	Receptive Language: Narrative and Text
3	Direct	Articulation: Sound Production	28	Direct	Receptive Language: Understanding Basic Concepts
4	Direct	Articulation: Transfer	29	Direct	Receptive Language: Understanding Directions and Sentences
6	Direct	Augmentative Communication: Expressive Symbols	30	Direct	Receptive Language: Vocabulary / Strategies
7	Direct	Augmentative Communication: Programming Device	31	Direct	Voice: Duration
8	Direct	Augmentative Communication: Symbol Discrimination	32	Direct	Voice: Loudness
9	Direct	Augmentative Communication: Symbol Identification	33	Direct	Voice: Pitch
10	Direct	Augmentative Communication: Transfer	34	Direct	Voice: Quality
11	Direct	Aural Rehabilitation: Auditory Discrimination	35	Direct	Voice: Resonance
12	Direct	Aural Rehabilitation: Compensation Techniques	36	Direct	Receptive and Expressive Communication feedback through Listening Technology in the Hearing Impaired Services
13	Direct	Aural Rehabilitation: Survival Speech Reading
14	Direct	Aural Rehabilitation: Survival Communication Repair Strategies
15	Direct	Expressive Language: Grammatical Forms
16	Direct	Expressive Language: Increase Length and Complexity of Utterances
17	Direct	Expressive Language: Semantics
18	Direct	Expressive Language: Social Interactions/Conversational Skills
19	Direct	Feeding / Swallowing: Advancement of Diet
20	Direct	Feeding / Swallowing: Compensatory Techniques
21	Direct	Feeding / Swallowing: Diet Modification
22	Direct	Feeding / Swallowing: Oral Motor
23	Direct	Fluency: Establish Fluency at Different Levels
24	Direct	Fluency: Strategies / Techniques
25	Direct	Fluency: Transfer

Speech, Language, and Hearing Therapy Services Log

www.leaderservices.com/pa ( sbap@leaderservices.com ( SBAP-Align support: (800) 360-8511
© 2013 Leader Services [PA0313]

Speech, Language and Hearing Therapy Services Log

Leader Services

2013-03-05

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Leader Services

Leader Services