Health Assured Session Audit

Patient ID Number

First

Allocated Psychotherapist

Date

Has the Client Self-Harmed Since The Last Session? *

Has the Client Currently Got Thoughts of Self-Harming? *

Does the Client Think About Ending His/Her Life? *

Does the Client Know How To End His/Her Life? *

Does the Client Think That Life is Not Worth Living? *

This Session Notes *

Key Areas To Address In The Next Session *

Current Session Number? *

Remaining Sessions

Is The Treatment Plan on Course For Completion within The Sessions Allocated? *

If No, How Many Additional Sessions is Forecasted?

Explain Rational of Request for Additional Sessions

Date of Next Session *

Psychotherapist Signature Confirmation *