SOAP Note
Updated with 2013 CPT Codes
SOAP note is a method of documentation developed for use by health care professionals. It is a clear and concise way to document the important information pertaining to each client visit. This 8 template Progress Note Kit was designed for mental health care professionals.
Taking notes in a consistent format benefits the mental health counselor, psychotherapist, psychologist or social worker. By following a specific documentation format for each client and each visit the therapist learns to focus in on the significant variables at play. Additionally, by following a specific format like SOAP in writing a progress note the professional counselor will be able to hone their note taking skills. This will save time and ultimately produce a more meaningful note that will aid the therapeutic process.
SOAP is actually an acronym that stands for:
- S – Subjective
- O – Objective
- A – Assessment
- P – Plan
Essentially a SOAP note documents the subjective data, objective data, the therapists assessment based on the subjective and objective, and then identifies the plan of action for the client. Another progress note format is the DAP which is a similar acronym and stands for:
- D – Data
- A – Assessment
- P – Plan
This Progress Note kit is an instant download and offers 2 styles of notes for mental health counselors: SOAP and DAP type format. They can be printed out and hand written or for counselors who prefer to write progress notes on their computer the downloads include automated templates as well.