Initials Key: Signature

Student (DOB): Student, Test (01/25/1969)

Month-End Billing Documentation for September 2011 Some School District

Diagnosis Code(s): 31539

Service Date Setting

09/01/2011 03

Time

Service

Activity(ies)

Progress/Comments

01:00 PM - 92508 TM 1. Produce /g/ initial in words, phrases, and sentences with slp visual/verbal cue as Goal Progress: PROGRESS

01:15 PM

needed.

/g/ in phrases with slp cue/model as needed. 7/10, 150x

Initials

09/06/2011 03

09/07/2011 03

01:00 PM 01:15 PM

92508 TM

1. Produce //sk in words, sentences, and conversation with slp cue/model as needed Goal Progress: PROGRESS

while participating in centers.

[Goal 1: 0]

Produced /sk/ in words with slp model 162x. 0/10 without model, with model

8/10

01:00 PM 01:15 PM

92508 TM 1. Produce /g/ initial in words, phrases, and sentences with slp visual/verbal cue as Goal Progress: PROGRESS

needed.

[Goal 1: 50] with slp model/cue.

Produced /sk/ in words 209x with slp model/cue.

09/08/2011 03

01:00 PM 01:15 PM

92508 TM 1. Produce /g/ initial in words, phrases, and sentences with slp visual/verbal cue as Goal Progress: PROGRESS

needed.

[Goal 1: 60]

with slp cue. /sk/ in wordsand phrases with slp cue as needed. 180x.

09/12/2011 03

09/13/2011 03

01:00 PM - 92508 TM 1. Produce /g/ initial in words, sentences, and conversation with slp cue/model as

01:15 PM

needed while participating in centers.

Goal Progress: PROGRESS [Goal 1: 80] Produced /sk/ blends in words, phrases, and sentences withs lp model/cue. 200x

01:00 PM 01:15 PM

92508 TM 1. Produce //sk in words, sentences, and conversation with slp cue/model as needed Goal Progress: PROGRESS

while participating in centers.

[Goal 1: 70]

/sk/ blends in words, phrases, and sentences with slp model/cue. 170x

09/14/2011 03

09/15/2011 03

01:00 PM 01:15 PM

92508 TM

1. Produce /g/ initial in words, phrases, and sentences with slp visual/verbal cue as needed.

Goal Progress: PROGRESS tested the following phonemes without slp cue. /g/ in words 12/15, sentences 8/10 /sk/ word 5/10

01:00 PM 01:15 PM

92508 TM 1. Produce /g/ initial in words, phrases, and sentences with slp visual/verbal cue as Goal Progress: PROGRESS

needed.

[Goal 1: 70]

/sk/ blends in words while playing bingo. 150x with minimal slp cueing

The signature below confirms the authenticity of the above initials as true representation of the signature and certifies that the IEP service(s) were accurately documented and personally rendered by the undersigned provider.

Initials Key:

Signature:

Test Therapist - Speech/Language Pathologist Extraordinaire

Page 1 of 2

Student (DOB): Student, Test (01/25/1969)

Month-End Billing Documentation for September 2011 Some School District

Diagnosis Code(s): 31539

Service Date Setting

09/19/2011 03

Time

Service

Activity(ies)

Progress/Comments

Initials

01:00 PM - 92508 TM 1. Produce /g/ initial in words, sentences, and conversation with slp cue/model as

01:15 PM

needed while participating in centers.

Goal Progress: PROGRESS Produced /sk/ in words/phrases with slp cue. 97x 60% Had to leave for early dismissal.

09/21/2011 03

01:00 PM 01:15 PM

92508 TM 1. Produce /g/ initial in words, phrases, and sentences with slp visual/verbal cue as Goal Progress: PROGRESS

needed.

[Goal 1: 73]

/sn/ in words and sentences with slp model/cue. 200x

09/22/2011 03

01:00 PM - 92508 TM 1. Produce /g/ initial in words, phrases, and sentences with slp visual/verbal cue as Goal Progress: PROGRESS

01:15 PM

needed.

Produced /sk/ in phrases with slp cue 150x.

09/26/2011 03

01:00 PM - 92508 TM 1. Produce /g/ initial in words, sentences, and conversation with slp cue/model as

01:15 PM

needed while participating in centers.

Goal Progress: PROGRESS /sk/ in words in varied /s/ blends with minimal slp cue 100%. substituted sk/st. Produced /st/ in words with slp cue.

09/27/2011 03

01:00 PM 01:15 PM

92508 TM 1. Produce //sk in words, sentences, and conversation with slp cue/model as needed Goal Progress: PROGRESS

while participating in centers.

produced /sk/ and /st/ in phrases to work on generalization 150x. 60% with

slp model/cue.

09/28/2011 03

01:00 PM - 92508 TM 1. Produce /g/ initial in words, phrases, and sentences with slp visual/verbal cue as Goal Progress: PROGRESS

01:15 PM

needed.

Produced /sk/ in sentences with slp model 150x. with 80% accuracy.

The signature below confirms the authenticity of the above initials as true representation of the signature and certifies that the IEP service(s) were accurately documented and personally rendered by the undersigned provider.

Initials Key:

Signature:

Test Therapist - Speech/Language Pathologist Extraordinaire

Page 2 of 2

Student (DOB): Student, Test (01/25/1969)

Month-End Billing Documentation for September 2011 Some School District

Diagnosis Code(s): 31532

Service Date Setting

09/02/2011 03

Time

Service

Activity(ies)

07:50 AM 07:50 AM

92508 TM

1. Read "Brennan's Bonfire" and answered wh-questions with slp visual cue. Identified and defined vocabulary, associations for (hayride, bonfire, scarecrow, straw/hay, crow, harvest moon). Introduced and identified "word of the week "synonyms" with slp vis

Progress/Comments

Goal Progress: PROGRESS Identified synonyms to story with slp cue 7/10. Answered wh-questions to story 9/10 with slp visual/cue. Used sentence cue to identify occupation in occupation Bingo. 19/20.

Initials

09/06/2011 03

01:50 PM 02:20 PM

92508 TM

1. Review "September Vocabulary", word/category/idiom (synonyms, insects, shake Goal Progress: PROGRESS

a leg) of week and to Brennan's Bonfire story and follow directions with vocabulary. Reviewed story from "Brennan's Hayride". Identified synonyms and defined

Formulate and write sentences with regular past tense verbs (ed). Play "Granny's (hayride, mare, scarecrow, straw, crow, wagon) 7/8. Followed directions

Candies"

with concepts in front/behind/over/next 7/7.

09/13/2011 03

07:50 AM 07:50 AM

92508 TM 1. Introduce category of the week and discuss with slp model/cue (space and solar system). Play irregular verb tense bingo with slp model/cue.

Goal Progress: PROGRESS Identified "solar system" and items associated with space with slp cue/model. Talked about the planets, moon/luna, and starts. Played irregular verb tense bingo 8/10 and formulated sentences with slp cue.

09/23/2011 03

01:50 PM 02:20 PM

92508 TM 1. Review word, category, idiom of the week and give examples. Introduce and read Goal Progress: PROGRESS

concept "Never and Always" and follow directions with slp visual/verbal cue. Play Sorted and identified category words with slp model/cue related to fall. no

past tene bingo (ed) with slp model/cue.

data.

09/30/2011 03

01:50 PM 02:20 PM

92508 TM 1. Review word, category, idiom of the week and give examples. Introduce and read Goal Progress: PROGRESS

concept "Never and Always" and follow directions with slp visual/verbal cue. Play Introduced grade level vocabulary, idiom, category with slp model Answered

past tene bingo (ed) with slp model/cue.

comprehension questions (inferencing) with slp model/cue. no data.

The signature below confirms the authenticity of the above initials as true representation of the signature and certifies that the IEP service(s) were accurately documented and personally rendered by the undersigned provider.

Initials Key:

Signature:

Test Therapist - Speech/Language Pathologist Extraordinaire

Page 1 of 1

Student (DOB): Student, Test (01/25/1969)

Month-End Billing Documentation for September 2011 Some School District

Diagnosis Code(s): 31532

Service Date Setting

09/02/2011 03

Time

Service

Activity(ies)

Progress/Comments

09:00 AM 09:20 AM

92508 TM

1. Review sports and answer "what" questions related to sports while playing game with slp model/cue.

Goal Progress: PROGRESS [Goal 1: 45] Reviewed and identified sports with slp visual cue 5/10. Followed directions with basketball vocabular with slp cue as needed (had difficulty with each, under, bleachers, backboard) 4/9. Reviewed he, she, they while playing verb bingo and repeating sentences 7/10.

Initials

09/06/2011 03

09/07/2011 03

09/08/2011 03

09/13/2011 03

09/15/2011 03

09/16/2011 03

09:00 AM 09:20 AM

92508 TM

1. Read "Hockey Book" and answer wh-questions with slp model/cue. Describe with Goal Progress: PROGRESS

2 attributes "sports" and make associations for sports with slp model/cue using

Introduced today/tomorrow concept with slp model/cue. Acted out and made

previously colored worksheet. . Follow directions with sports vocabulary and

associations for "sports" with slp cue. Had to leave early for picture day.

concept "on" with

09:00 AM 09:20 AM

92508 TM

1. Read "Sports Book" and answer wh-questions with slp model/cue. Describe with Goal Progress: PROGRESS

2 attributes "sports" and make associations for sports with slp model/cue using

Read "Hockey" book and introduced sport vocabulary and associations with

dinosaur board. . Follow directions with sports vocabulary and concept "on" with slp slp model/cue. Identified and labeled sports with slp model/cue 5/10.

model/cue

09:00 AM 09:20 AM

92508 TM

1. Play "sports" grammar board game, focusing on using 4-6 word phrases,

Goal Progress: PROGRESS

describing sports with attributes, and using appropriate pronoun. Read "sports bood" Read "Soccer" book to identify associations and soccer/sports vocabulary

and answer wh-questions with slp model/cue. Review concepts "on" with wipe on with slp cue. Answered wh-questions about pictures/story 3/7 with slp cue.

board and using comp

Identified 5 sports.

09:00 AM 09:20 AM

92508 TM

1. Read "Hockey Book" and answer wh-questions with slp model/cue. Describe with Goal Progress: PROGRESS

2 attributes "sports" and make associations for sports with slp model/cue using

Reviewed "sports". Read book on "golf" and golf parts, associations with slp

previously colored worksheet. . Follow directions with sports vocabulary and

cue. Answered wh-questions to a story with slp model/cue 5/10.

concept "on" with

09:00 AM 09:20 AM

09:00 AM 09:20 AM

92508 TM 1. Read "volleyball" and answer wh-questions with slp model/cue. Introduce and model concept of "who" while playing "who bingo" with slp cue/model.

Goal Progress: PROGRESS Introduced and read a book on "volleyball" with slp cue. Described actions in the pictures with slp cue 5/8. Identified associations and parts with slp/cue. Answered yes/no questions 4/4 with slp cue. Played "who" bingo with slp visual cue 8/14.

92508 TM

1. Read "gymnastics book" to identify and categorize sports. Compared sports by Goal Progress: PROGRESS

parts, balls, function. Answered wh-questions about sports/balls with slp cue. Played Read and answered wh-questions about gymnastics/sports with slp cue

"who" bingo with slp model/cue.

8/10. Identified function of objects 8/10 with sports. Answered who questions

with slp visual/verbal cue 4/9.

The signature below confirms the authenticity of the above initials as true representation of the signature and certifies that the IEP service(s) were accurately documented and personally rendered by the undersigned provider.

Initials Key:

Signature:

Test Therapist - Speech/Language Pathologist Extraordinaire

Page 1 of 2

Student (DOB): Student, Test (01/25/1969)

Month-End Billing Documentation for September 2011 Some School District

Diagnosis Code(s): 31532

Service Date Setting

09/23/2011 03

Time

Service

Activity(ies)

08:50 AM 09:20 AM

92508 TM 1. Review month, day, season vocabulary with slp visual/verbal cue and things associated with it. Describe actions, pictures scenes of fall with slp model/cue. Identify/review sports played in the fall with slp model cue.

Progress/Comments

Goal Progress: PROGRESS Review month, day, season vocabulary with slp visual/verbal cue and things associated with it. 6/10 Describe actions, pictures scenes of fall with slp model/cue. (jumping, raking, playing football, falling, chilly, rake, sweater, etc) 7/10Identify/review sports played in the fall with slp model cue. 8/10

Initials

09/27/2011 03

09:00 AM 09:20 AM

92508 TM 1. Review categories of (month, week, day, holidays, seasons, and associations) with slp model/cue. Followed -2 part directions with Hear Builder (large, small, colors, next, beside). with minimal slp cue.

Goal Progress: PROGRESS Followed directions with color, next, beside, above, below 1-2 part directions with 75% accuracy. Identified month 0/1, seasong with choice, holiday with picture cue, associations with picture cues.

The signature below confirms the authenticity of the above initials as true representation of the signature and certifies that the IEP service(s) were accurately documented and personally rendered by the undersigned provider.

Initials Key:

Signature:

Test Therapist - Speech/Language Pathologist Extraordinaire

Page 2 of 2

Student (DOB): Student, Test (01/25/1969)

Month-End Billing Documentation for September 2011 Some School District

Diagnosis Code(s): 31532

Service Date Setting

09/02/2011 03

Time

Service

Activity(ies)

Progress/Comments

12:15 PM 12:30 PM

92508 TM 1. produce /k/, /t/, /g/, and /d/ in words, phrases, and sentences with slp visual/verbal Goal Progress: PROGRESS

cue as needed.

[Goal 1: 75]

Produced /ch/ in words without slp cue. 50x

Initials

09/07/2011 03

12:15 PM 12:30 PM

92508 TM 1. Produce /ch/ in all position of words, phrases, and sentences with slp visual/verbal Goal Progress: PROGRESS

cue as needed.

Produced /ch/ in words, phrases, sentences with slp model/cue 152x. no

data

09/12/2011 03

12:15 PM 12:30 PM

92508 TM 1. Produce /ch/ in all position of words, phrases, and sentences with slp visual/verbal Goal Progress: PROGRESS

cue as needed.

[Goal 1: 70]

/ch/ in phrases with slp model/cue as needed 150x.

09/13/2011 03

12:15 PM - 92508 TM 1. Produce /ch/ in all position of words, phrases, and sentences with slp visual/verbal Goal Progress: PROGRESS

12:30 PM

cue as needed.

produced /ch/ in words and sentences with slp cue as needed 150x. no data

09/14/2011 03

09/19/2011 03

12:15 PM 12:30 PM

92508 TM

1. Produce /ch/ in all position of words, phrases, and sentences with slp visual/verbal Goal Progress: PROGRESS

cue as needed.

[Goal 1: 85]

Tested /ch/ in words, medial position, and sentences with slp ceu. 35/41.

medial position 21/25

12:15 PM - 92508 TM 1. Produce /ch/ in all position of words, phrases, and sentences with slp visual/verbal Goal Progress: PROGRESS

12:30 PM

cue as needed.

Complained of missing writing. /ch/ in words and phrases with slp cue 83%

09/22/2011 03

12:15 PM - 92508 TM 1. Check speech in conversation with slp cue as needed. 12:30 PM

Goal Progress: PROGRESS In converstion /s/ with tongue protrusion, /ch/, /sh/ sound slushy.

09/23/2011 03

12:20 PM - 92508 TM 1. produce /k/, /t/, /g/, and /d/ in words, phrases, and sentences with slp visual/verbal Goal Progress: PROGRESS

12:30 PM

cue as needed.

Formulated sentences with /ch/ with slp cue as needed with 90% accuracy.

The signature below confirms the authenticity of the above initials as true representation of the signature and certifies that the IEP service(s) were accurately documented and personally rendered by the undersigned provider.

Initials Key:

Signature:

Test Therapist - Speech/Language Pathologist Extraordinaire

Page 1 of 2

Student (DOB): Student, Test (01/25/1969)

Month-End Billing Documentation for September 2011 Some School District

Diagnosis Code(s): 31532

Service Date Setting

09/26/2011 03

Time

Service

Activity(ies)

Progress/Comments

12:15 PM - 92508 TM 1. Produce /ch/ in all position of words, phrases, and sentences with slp visual/verbal Goal Progress: PROGRESS

12:30 PM

cue as needed.

/ch/ in sentences made by Chris with slp cue as needed 80%.

Initials

09/27/2011 03

12:15 PM - 92508 TM 1. Produce /ch/ in all position of words, phrases, and sentences with slp visual/verbal Goal Progress: PROGRESS

12:30 PM

cue as needed.

Answered questions to work on generalization of /ch/. 80% with slp cue.

09/28/2011 03

12:15 PM 12:30 PM

92508 TM 1. Produce /ch/ in all position of words, phrases, and sentences with slp visual/verbal Goal Progress: PROGRESS

cue as needed.

Produced /ch/ in words 100x focusing on keeping tongue in for /ch/ and /s/

with slp cue.

The signature below confirms the authenticity of the above initials as true representation of the signature and certifies that the IEP service(s) were accurately documented and personally rendered by the undersigned provider.

Initials Key:

Signature:

Test Therapist - Speech/Language Pathologist Extraordinaire

Page 2 of 2

Student (DOB): Student, Test (01/25/1969)

Month-End Billing Documentation for September 2011 Some School District

Diagnosis Code(s): 31539

Service Date Setting

09/06/2011 03

Time

Service

Activity(ies)

Progress/Comments

01:15 PM 01:30 PM

92508 TM 1. Produce /sn/ blends in words, phrases, and sentences with slp visual/verbal cue as needed.

Goal Progress: PROGRESS [Goal 1: 70] /sn/ in words with slp without model 155x

Initials

09/07/2011 03

01:15 PM 01:30 PM

92508 TM 1. Produce /sn/ blends in words, phrases, and sentences with slp visual/verbal cue as needed.

Goal Progress: PROGRESS [Goal 1: 70] Produced /sn/ in words/phrases with slp model/cue 158

09/08/2011 03

01:15 PM 01:45 PM

92508 TM 1. Produce /sn/ blends in words, sentences, and conversation with slp cue/model as Goal Progress: PROGRESS

needed while participating in centers.

[Goal 1: 90]

/sn/ in words and phrases with slp cue as needed 200x.

09/13/2011 03

01:15 PM 01:30 PM

92508 TM 1. Produce /sn/ blends in words, phrases, and sentences with slp visual/verbal cue as needed.

Goal Progress: PROGRESS [Goal 1: 80] /sn/ in phrases with slp model/cue. 160x

09/14/2011 03

01:15 PM 01:30 PM

92508 TM 1. Produce /sn/ blends in words, phrases, and sentences with slp visual/verbal cue as needed.

Goal Progress: PROGRESS tested /sn/ in words 9/10, phrases/sentence 8/10. Had some difficulty with other /s/ blends (st).

09/15/2011 03

01:15 PM 01:45 PM

92508 TM 1. Produce /sn/ blends in words, sentences, and conversation with slp cue/model as Goal Progress: PROGRESS

needed while participating in centers.

[Goal 1: 70]

/s/ blends varied to check /sn/ blend without slp cue.

09/19/2011 03

01:15 PM 01:30 PM

92508 TM 1. Produce /sn/ blends in words, phrases, and sentences with slp visual/verbal cue as needed.

Goal Progress: PROGRESS [Goal 1: 75] /sn/ blends in words, phrases, and sentences with minimal slp cue.

09/21/2011 03

01:15 PM 01:30 PM

92508 TM 1. Produce /sn/ blends in words, phrases, and sentences with slp visual/verbal cue as needed.

Goal Progress: PROGRESS [Goal 1: 90] Produced /sn/ in words and sentences with slp cue 150x

The signature below confirms the authenticity of the above initials as true representation of the signature and certifies that the IEP service(s) were accurately documented and personally rendered by the undersigned provider.

Initials Key:

Signature:

Test Therapist - Speech/Language Pathologist Extraordinaire

Page 1 of 2

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