Form DOC13-377 "Mental Health Group Note" - Washington

What Is Form DOC13-377?

This is a legal form that was released by the Washington State Department of Corrections - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 19, 2019;
  • The latest edition provided by the Washington State Department of Corrections;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DOC13-377 by clicking the link below or browse more documents and templates provided by the Washington State Department of Corrections.

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Download Form DOC13-377 "Mental Health Group Note" - Washington

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PATIENT I.D. DATA:
(Name, DOC#, DOB)
MENTAL HEALTH GROUP NOTE
DATE
TIME
FACILITY
UNIT (optional)
GROUP
PARTICIPATION
High
Moderate
Low
None
Focused
Attentive
Distracted
Disruptive
NARRATIVE
SIGNATURE OF CLINICIAN:
NAME AND TITLE OF CLINICIAN:
Page 1 of 1
State law and/or federal regulations prohibit disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law.
DOC 13-377 (12/19/2019)
MENTAL HEALTH: Progress Notes
Data classification category 1
PATIENT I.D. DATA:
(Name, DOC#, DOB)
MENTAL HEALTH GROUP NOTE
DATE
TIME
FACILITY
UNIT (optional)
GROUP
PARTICIPATION
High
Moderate
Low
None
Focused
Attentive
Distracted
Disruptive
NARRATIVE
SIGNATURE OF CLINICIAN:
NAME AND TITLE OF CLINICIAN:
Page 1 of 1
State law and/or federal regulations prohibit disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law.
DOC 13-377 (12/19/2019)
MENTAL HEALTH: Progress Notes
Data classification category 1