Date of group: Patient Initials: Start time: End Time: CPT Code: Group name: Number of attendees: Number of those who did not attend: Number of those leading the group: Behaviors observed in the group: Observations of members in the group:
Date of group: Patient Initials: Start time: End Time: CPT Code: Group name: Number of attendees: Number of those who did not attend: Number of those leading the group: Behaviors observed in the group: Observations of members in the group: