Speech, Language and Hearing Therapy Services Log



|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 |Sta|End Time |

| |rt | |

| |Tim| |

| |e | |

|D- Direct Session | |MN- Maintaining |MS- Mastering |

|DM- Direct Session: Make-up Session | |RG- Regressing |IN- Inconsistent |

| | |PR- Progressing | |

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

|Treatment Key: |Page 2 of 2 |

|1 |Direct |Articulation: Discrimination |25 |Direct |Phonological Awareness |

|2 |Direct |Articulation: Oral Motor |26 |Direct |Receptive Language: Narrative and Text |

|3 |Direct |Articulation: Sound Production |27 |Direct |Receptive Language: Understanding Basic Concepts |

|4 |Direct |Articulation: Transfer |28 |Direct |Receptive Language: Understanding Directions and Sentences |

|5 |Direct |Augmentative Communication: Expressive Symbols |29 |Direct |Receptive Language: Vocabulary / Strategies |

|6 |Direct |Augmentative Communication: Programming Device |30 |Direct |Voice: Duration |

|7 |Direct |Augmentative Communication: Symbol Discrimination |31 |Direct |Voice: Loudness |

|8 |Direct |Augmentative Communication: Symbol Identification |32 |Direct |Voice: Pitch |

|9 |Direct |Augmentative Communication: Transfer |33 |Direct |Voice: Quality |

|10 |Direct |Aural Rehabilitation: Auditory Discrimination |34 |Direct |Voice: Resonance |

|11 |Direct |Aural Rehabilitation: Compensation Techniques |35 |Direct |Receptive and Expressive Communication feedback through Listening Technology in the Hearing Impaired |

| | | | | |Services |

|12 |Direct |Aural Rehabilitation: Survival Speech Reading |36 |Direct |Other Direct Service |

|14 |Direct |Expressive Language: Grammatical Forms | | | |

|15 |Direct |Expressive Language: Increase Length and Complexity of Utterances | | | |

|16 |Direct |Expressive Language: Semantics | | | |

|17 |Direct |Expressive Language: Social Interactions/Conversational Skills | | | |

|18 |Direct |Feeding / Swallowing: Advancement of Diet | | | |

|19 |Direct |Feeding / Swallowing: Compensatory Techniques | | | |

|20 |Direct |Feeding / Swallowing: Diet Modification | | | |

|21 |Direct |Feeding / Swallowing: Oral Motor | | | |

|22 |Direct |Fluency: Establish Fluency at Different Levels | | | |

|23 |Direct |Fluency: Strategies / Techniques | | | |

|24 |Direct |Fluency: Transfer | | | |

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