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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