initials key: signaturetherapylog.typepad.com/direct_service_provider/documents/sample... · /sk/...

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Month-End Billing Documentation for September 2011 Some School District Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539 Service Date Setting Time Service Activity(ies) Progress/Comments Initials 09/01/2011 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 /g/ in phrases with slp cue/model as needed. 7/10, 150x 09/06/2011 03 01:00 PM - 01:15 PM 92508 TM 1. Produce //sk in words, sentences, and conversation with slp cue/model as needed while participating in centers. Goal Progress: PROGRESS [Goal 1: 0] Produced /sk/ in words with slp model 162x. 0/10 without model, with model 8/10 09/07/2011 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 [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 needed. Goal Progress: PROGRESS [Goal 1: 60] with slp cue. /sk/ in wordsand phrases with slp cue as needed. 180x. 09/12/2011 03 01:00 PM - 01:15 PM 92508 TM 1. Produce /g/ initial in words, sentences, and conversation with slp cue/model as needed while participating in centers. Goal Progress: PROGRESS [Goal 1: 80] Produced /sk/ blends in words, phrases, and sentences withs lp model/cue. 200x 09/13/2011 03 01:00 PM - 01:15 PM 92508 TM 1. Produce //sk in words, sentences, and conversation with slp cue/model as needed while participating in centers. Goal Progress: PROGRESS [Goal 1: 70] /sk/ blends in words, phrases, and sentences with slp model/cue. 170x 09/14/2011 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 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 [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

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Page 1: Initials Key: Signaturetherapylog.typepad.com/direct_service_provider/Documents/SAMPLE... · /sk/ blends in words while playing bingo. 150x with minimal slp cueing ... Review word,

Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/01/201103

01:00 PM -01:15 PM

92508 TM 1. Produce /g/ initial in words, phrases, and sentences with slp visual/verbal cue asneeded.

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

09/06/201103

01:00 PM -01:15 PM

92508 TM 1. Produce //sk in words, sentences, and conversation with slp cue/model as neededwhile participating in centers.

Goal Progress: PROGRESS[Goal 1: 0]Produced /sk/ in words with slp model 162x. 0/10 without model, with model8/10

09/07/201103

01:00 PM -01:15 PM

92508 TM 1. Produce /g/ initial in words, phrases, and sentences with slp visual/verbal cue asneeded.

Goal Progress: PROGRESS[Goal 1: 50] with slp model/cue.Produced /sk/ in words 209x with slp model/cue.

09/08/201103

01:00 PM -01:15 PM

92508 TM 1. Produce /g/ initial in words, phrases, and sentences with slp visual/verbal cue asneeded.

Goal Progress: PROGRESS[Goal 1: 60]with slp cue. /sk/ in wordsand phrases with slp cue as needed. 180x.

09/12/201103

01:00 PM -01:15 PM

92508 TM 1. Produce /g/ initial in words, sentences, and conversation with slp cue/model asneeded while participating in centers.

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

09/13/201103

01:00 PM -01:15 PM

92508 TM 1. Produce //sk in words, sentences, and conversation with slp cue/model as neededwhile participating in centers.

Goal Progress: PROGRESS[Goal 1: 70]/sk/ blends in words, phrases, and sentences with slp model/cue. 170x

09/14/201103

01:00 PM -01:15 PM

92508 TM 1. Produce /g/ initial in words, phrases, and sentences with slp visual/verbal cue asneeded.

Goal Progress: PROGRESStested the following phonemes without slp cue. /g/ in words 12/15, sentences8/10 /sk/ word 5/10

09/15/201103

01:00 PM -01:15 PM

92508 TM 1. Produce /g/ initial in words, phrases, and sentences with slp visual/verbal cue asneeded.

Goal Progress: PROGRESS[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

Page 2: Initials Key: Signaturetherapylog.typepad.com/direct_service_provider/Documents/SAMPLE... · /sk/ blends in words while playing bingo. 150x with minimal slp cueing ... Review word,

Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/19/201103

01:00 PM -01:15 PM

92508 TM 1. Produce /g/ initial in words, sentences, and conversation with slp cue/model asneeded while participating in centers.

Goal Progress: PROGRESSProduced /sk/ in words/phrases with slp cue. 97x 60% Had to leave for earlydismissal.

09/21/201103

01:00 PM -01:15 PM

92508 TM 1. Produce /g/ initial in words, phrases, and sentences with slp visual/verbal cue asneeded.

Goal Progress: PROGRESS[Goal 1: 73]/sn/ in words and sentences with slp model/cue. 200x

09/22/201103

01:00 PM -01:15 PM

92508 TM 1. Produce /g/ initial in words, phrases, and sentences with slp visual/verbal cue asneeded.

Goal Progress: PROGRESSProduced /sk/ in phrases with slp cue 150x.

09/26/201103

01:00 PM -01:15 PM

92508 TM 1. Produce /g/ initial in words, sentences, and conversation with slp cue/model asneeded while participating in centers.

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

09/27/201103

01:00 PM -01:15 PM

92508 TM 1. Produce //sk in words, sentences, and conversation with slp cue/model as neededwhile participating in centers.

Goal Progress: PROGRESSproduced /sk/ and /st/ in phrases to work on generalization 150x. 60% withslp model/cue.

09/28/201103

01:00 PM -01:15 PM

92508 TM 1. Produce /g/ initial in words, phrases, and sentences with slp visual/verbal cue asneeded.

Goal Progress: PROGRESSProduced /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

Page 3: Initials Key: Signaturetherapylog.typepad.com/direct_service_provider/Documents/SAMPLE... · /sk/ blends in words while playing bingo. 150x with minimal slp cueing ... Review word,

Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/02/201103

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

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

09/06/201103

01:50 PM -02:20 PM

92508 TM 1. Review "September Vocabulary", word/category/idiom (synonyms, insects, shakea leg) of week and to Brennan's Bonfire story and follow directions with vocabulary.Formulate and write sentences with regular past tense verbs (ed). Play "Granny'sCandies"

Goal Progress: PROGRESSReviewed story from "Brennan's Hayride". Identified synonyms and defined(hayride, mare, scarecrow, straw, crow, wagon) 7/8. Followed directionswith concepts in front/behind/over/next 7/7.

09/13/201103

07:50 AM -07:50 AM

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

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

09/23/201103

01:50 PM -02:20 PM

92508 TM 1. Review word, category, idiom of the week and give examples. Introduce and readconcept "Never and Always" and follow directions with slp visual/verbal cue. Playpast tene bingo (ed) with slp model/cue.

Goal Progress: PROGRESSSorted and identified category words with slp model/cue related to fall. nodata.

09/30/201103

01:50 PM -02:20 PM

92508 TM 1. Review word, category, idiom of the week and give examples. Introduce and readconcept "Never and Always" and follow directions with slp visual/verbal cue. Playpast tene bingo (ed) with slp model/cue.

Goal Progress: PROGRESSIntroduced grade level vocabulary, idiom, category with slp model Answeredcomprehension 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

Page 4: Initials Key: Signaturetherapylog.typepad.com/direct_service_provider/Documents/SAMPLE... · /sk/ blends in words while playing bingo. 150x with minimal slp cueing ... Review word,

Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/02/201103

09:00 AM -09:20 AM

92508 TM 1. Review sports and answer "what" questions related to sports while playing gamewith slp model/cue.

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

09/06/201103

09:00 AM -09:20 AM

92508 TM 1. Read "Hockey Book" and answer wh-questions with slp model/cue. Describe with2 attributes "sports" and make associations for sports with slp model/cue usingpreviously colored worksheet. . Follow directions with sports vocabulary andconcept "on" with

Goal Progress: PROGRESSIntroduced today/tomorrow concept with slp model/cue. Acted out and madeassociations for "sports" with slp cue. Had to leave early for picture day.

09/07/201103

09:00 AM -09:20 AM

92508 TM 1. Read "Sports Book" and answer wh-questions with slp model/cue. Describe with2 attributes "sports" and make associations for sports with slp model/cue usingdinosaur board. . Follow directions with sports vocabulary and concept "on" with slpmodel/cue

Goal Progress: PROGRESSRead "Hockey" book and introduced sport vocabulary and associations withslp model/cue. Identified and labeled sports with slp model/cue 5/10.

09/08/201103

09:00 AM -09:20 AM

92508 TM 1. Play "sports" grammar board game, focusing on using 4-6 word phrases,describing sports with attributes, and using appropriate pronoun. Read "sports bood"and answer wh-questions with slp model/cue. Review concepts "on" with wipe onboard and using comp

Goal Progress: PROGRESSRead "Soccer" book to identify associations and soccer/sports vocabularywith slp cue. Answered wh-questions about pictures/story 3/7 with slp cue.Identified 5 sports.

09/13/201103

09:00 AM -09:20 AM

92508 TM 1. Read "Hockey Book" and answer wh-questions with slp model/cue. Describe with2 attributes "sports" and make associations for sports with slp model/cue usingpreviously colored worksheet. . Follow directions with sports vocabulary andconcept "on" with

Goal Progress: PROGRESSReviewed "sports". Read book on "golf" and golf parts, associations with slpcue. Answered wh-questions to a story with slp model/cue 5/10.

09/15/201103

09:00 AM -09:20 AM

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

Goal Progress: PROGRESSIntroduced and read a book on "volleyball" with slp cue. Described actions inthe 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 slpvisual cue 8/14.

09/16/201103

09:00 AM -09:20 AM

92508 TM 1. Read "gymnastics book" to identify and categorize sports. Compared sports byparts, balls, function. Answered wh-questions about sports/balls with slp cue. Played"who" bingo with slp model/cue.

Goal Progress: PROGRESSRead and answered wh-questions about gymnastics/sports with slp cue8/10. Identified function of objects 8/10 with sports. Answered who questionswith 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

Page 5: Initials Key: Signaturetherapylog.typepad.com/direct_service_provider/Documents/SAMPLE... · /sk/ blends in words while playing bingo. 150x with minimal slp cueing ... Review word,

Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/23/201103

08:50 AM -09:20 AM

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

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

09/27/201103

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: PROGRESSFollowed directions with color, next, beside, above, below 1-2 part directionswith 75% accuracy. Identified month 0/1, seasong with choice, holiday withpicture 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

Page 6: Initials Key: Signaturetherapylog.typepad.com/direct_service_provider/Documents/SAMPLE... · /sk/ blends in words while playing bingo. 150x with minimal slp cueing ... Review word,

Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/02/201103

12:15 PM -12:30 PM

92508 TM 1. produce /k/, /t/, /g/, and /d/ in words, phrases, and sentences with slp visual/verbalcue as needed.

Goal Progress: PROGRESS[Goal 1: 75]Produced /ch/ in words without slp cue. 50x

09/07/201103

12:15 PM -12:30 PM

92508 TM 1. Produce /ch/ in all position of words, phrases, and sentences with slp visual/verbalcue as needed.

Goal Progress: PROGRESSProduced /ch/ in words, phrases, sentences with slp model/cue 152x. nodata

09/12/201103

12:15 PM -12:30 PM

92508 TM 1. Produce /ch/ in all position of words, phrases, and sentences with slp visual/verbalcue as needed.

Goal Progress: PROGRESS[Goal 1: 70]/ch/ in phrases with slp model/cue as needed 150x.

09/13/201103

12:15 PM -12:30 PM

92508 TM 1. Produce /ch/ in all position of words, phrases, and sentences with slp visual/verbalcue as needed.

Goal Progress: PROGRESSproduced /ch/ in words and sentences with slp cue as needed 150x. no data

09/14/201103

12:15 PM -12:30 PM

92508 TM 1. Produce /ch/ in all position of words, phrases, and sentences with slp visual/verbalcue as needed.

Goal Progress: PROGRESS[Goal 1: 85]Tested /ch/ in words, medial position, and sentences with slp ceu. 35/41.medial position 21/25

09/19/201103

12:15 PM -12:30 PM

92508 TM 1. Produce /ch/ in all position of words, phrases, and sentences with slp visual/verbalcue as needed.

Goal Progress: PROGRESSComplained of missing writing. /ch/ in words and phrases with slp cue 83%

09/22/201103

12:15 PM -12:30 PM

92508 TM 1. Check speech in conversation with slp cue as needed. Goal Progress: PROGRESSIn converstion /s/ with tongue protrusion, /ch/, /sh/ sound slushy.

09/23/201103

12:20 PM -12:30 PM

92508 TM 1. produce /k/, /t/, /g/, and /d/ in words, phrases, and sentences with slp visual/verbalcue as needed.

Goal Progress: PROGRESSFormulated 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

Page 7: Initials Key: Signaturetherapylog.typepad.com/direct_service_provider/Documents/SAMPLE... · /sk/ blends in words while playing bingo. 150x with minimal slp cueing ... Review word,

Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/26/201103

12:15 PM -12:30 PM

92508 TM 1. Produce /ch/ in all position of words, phrases, and sentences with slp visual/verbalcue as needed.

Goal Progress: PROGRESS/ch/ in sentences made by Chris with slp cue as needed 80%.

09/27/201103

12:15 PM -12:30 PM

92508 TM 1. Produce /ch/ in all position of words, phrases, and sentences with slp visual/verbalcue as needed.

Goal Progress: PROGRESSAnswered questions to work on generalization of /ch/. 80% with slp cue.

09/28/201103

12:15 PM -12:30 PM

92508 TM 1. Produce /ch/ in all position of words, phrases, and sentences with slp visual/verbalcue as needed.

Goal Progress: PROGRESSProduced /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

Page 8: Initials Key: Signaturetherapylog.typepad.com/direct_service_provider/Documents/SAMPLE... · /sk/ blends in words while playing bingo. 150x with minimal slp cueing ... Review word,

Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/06/201103

01:15 PM -01:30 PM

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

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

09/07/201103

01:15 PM -01:30 PM

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

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

09/08/201103

01:15 PM -01:45 PM

92508 TM 1. Produce /sn/ blends in words, sentences, and conversation with slp cue/model asneeded while participating in centers.

Goal Progress: PROGRESS[Goal 1: 90] /sn/ in words and phrases with slp cue as needed 200x.

09/13/201103

01:15 PM -01:30 PM

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

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

09/14/201103

01:15 PM -01:30 PM

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

Goal Progress: PROGRESStested /sn/ in words 9/10, phrases/sentence 8/10. Had some difficulty withother /s/ blends (st).

09/15/201103

01:15 PM -01:45 PM

92508 TM 1. Produce /sn/ blends in words, sentences, and conversation with slp cue/model asneeded while participating in centers.

Goal Progress: PROGRESS[Goal 1: 70]/s/ blends varied to check /sn/ blend without slp cue.

09/19/201103

01:15 PM -01:30 PM

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

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

09/21/201103

01:15 PM -01:30 PM

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

Page 9: Initials Key: Signaturetherapylog.typepad.com/direct_service_provider/Documents/SAMPLE... · /sk/ blends in words while playing bingo. 150x with minimal slp cueing ... Review word,

Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/22/201103

01:15 PM -01:45 PM

92508 TM 1. Produce /sn/ blends in words, sentences, and conversation with slp cue/model asneeded while participating in centers.

Goal Progress: PROGRESS/sn/ with other /s/ blends varied with slp cue as needed 150x.

09/28/201103

01:15 PM -01:30 PM

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

Goal Progress: PROGRESSModeled /s/ compared to /s/ blends with slp model/cue. no data.

09/29/201103

01:15 PM -01:45 PM

92508 TM 1. Produce /sn/ blends in words, sentences, and conversation with slp cue/model asneeded while participating in centers.

Goal Progress: PROGRESS/s/ seperated in words 150x 50 with cues. 0% in words without 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

Page 10: Initials Key: Signaturetherapylog.typepad.com/direct_service_provider/Documents/SAMPLE... · /sk/ blends in words while playing bingo. 150x with minimal slp cueing ... Review word,

Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/01/201103

03:00 PM -03:15 PM

92508 TM 1. Produce /r/ in words, phrases, and sentences with slp cue as needed whileparticipating in centers.

Goal Progress: PROGRESS[Goal 1: 50]Produced vocalic /r/ in words/phrases with slp model/cue as needed. 100z

09/06/201103

03:00 PM -03:15 PM

92508 TM 1. Produce /r/ in words, phrases, and sentences with slp cue as needed whileparticipating in centers.

Goal Progress: PROGRESS[Goal 1: 70]with model. produced vocalic /r/ in words and phrases with slp cue asneeded 150x.

09/07/201103

03:00 PM -03:15 PM

92508 TM 1. Produce /r/ in words, phrases, and sentences with slp cue as needed whileparticipating in centers.

Goal Progress: PROGRESSProduced vocalic /r/ in words, phrases, and sentences with slp model/cue asneeded 162x.

09/08/201103

03:00 PM -03:15 PM

92508 TM 1. Produce /r/ in words, phrases, and sentences with slp cue as needed whileparticipating in centers.

Goal Progress: PROGRESS[Goal 1: 93]Produced /r/ in words with slp cue as needed. 150x

09/12/201103

03:00 PM -03:15 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, sentences, and conversation with slpcue/model as needed while participating in centers.

Goal Progress: PROGRESS/r/ and vocalic /r/ in conversation. Able to correct 50%.

09/13/201103

03:00 PM -03:15 PM

92508 TM 1. Produce /r/ in words, phrases, and sentences with slp cue as needed whileparticipating in centers.

Goal Progress: PROGRESS[Goal 1: 50]vocalic /r/ in words and phrases with slp model/cue.

09/14/201103

03:00 PM -03:15 PM

92508 TM 1. Produce /r/ in words, phrases, and sentences with slp cue as needed whileparticipating in centers.

Goal Progress: PROGRESS[Goal 1: 64]tested vocalic /r/ in words

09/15/201103

03:00 PM -03:15 PM

92508 TM 1. Produce /r/ in words, phrases, and sentences with slp cue as needed whileparticipating in centers.

Goal Progress: PROGRESS[Goal 1: 70]vocalic /r/ in sentences 150x while playing bingo. 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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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/19/201103

03:00 PM -03:15 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, sentences, and conversation with slpcue/model as needed while participating in centers.

Goal Progress: PROGRESSvocalic /r/ in words 150x. no data

09/21/201103

03:00 PM -03:15 PM

92508 TM 1. Produce /r/ in words, phrases, and sentences with slp cue as needed whileparticipating in centers.

Goal Progress: PROGRESS/r/ and vocalic /r/ in words with slp cue as needed. 150x. no data

09/22/201103

03:00 PM -03:15 PM

92508 TM 1. Produce /r/ in words, phrases, and sentences with slp cue as needed whileparticipating in centers.

Goal Progress: PROGRESS/r/ in sentences with slp cue as needed 150x.

09/26/201103

03:00 PM -03:15 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, sentences, and conversation with slpcue/model as needed while participating in centers.

Goal Progress: PROGRESS/r/ in sentences while playing a game with minimal slp cue 80%.

09/28/201103

03:00 PM -03:15 PM

92508 TM 1. Produce /r/ in words, phrases, and sentences with slp cue as needed whileparticipating in centers.

Goal Progress: PROGRESSvocalic /r/ in phrases with slp model/cue 150x. with 70%.

09/29/201103

03:00 PM -03:15 PM

92508 TM 1. Produce /r/ in words, phrases, and sentences with slp cue as needed whileparticipating in centers.

Goal Progress: PROGRESSvocalic /r/ in words, phrases with 63%, in conversation 30% with slp cue asneeded.

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

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/02/201103

10:00 AM -10:30 AM

92508 TM 1. Define grade level vocabulary, synonyms, and idioms with slp model/cue asneeded. Use context clues to identify and answer questions to grade level story withslp model/cue.2. Produce and formulate sentences with appropriate regular past tense verb (ed)while playing bingo with slp cue as needed.3. Define grade level vocabulary, synonyms, and idioms with slp model/cue asneeded. Use context clues to identify and answer questions to grade level story withslp model/cue.

Goal Progress: PROGRESS, PROGRESS, PROGRESSIdentified and formulated sentences with regular past tnese verbs (ed) 20/20.Defined vocabulary 5/7. Identified synonyms 3/4 without slp cue. Definedidiom of the week (wrong side of the bed) with slp model/cue, word of theweek, and category of the week) 1/3. Focused on context cues to answerwh-questions to story, needed slp cue to point them out.

09/07/201103

10:00 AM -10:30 AM

92508 TM 1. Intoduce, define, draw pictures for grade level vocabulary (shimmer, eerie,swallows, lurk, climate, silken, and lumbering) with slp model/cue.2. Answer wh-questions to grade level story using context cues, with slp model/cue.Introduce main idea of story and identify details (if time) with slp model/cue.

Goal Progress: PROGRESS, PROGRESSIntroduced and defined grade level vocabulary with synonyms with slpmodel/cue and context 4/8. Identified main idea vs. details when given apicture. 3/6.

09/14/201103

10:00 AM -10:30 AM

92508 TM 1. Intoduce, define, draw pictures for grade level vocabulary (roamed, completed,natural, wildlife) with slp model/cue. Answer wh-questions about main idea andidentify story details with slp scaffolding and modeling.2. Answer wh-questions about main idea of story and identify details (if time) withslp scaffolding/model/cue.

Goal Progress: PROGRESS, PROGRESSIntroduced defined, and formulated sentences for class vocabualry 1/5.Identified main idea and details for category of the week (solarsystem/space).

09/16/201103

10:00 AM -10:30 AM

92508 TM 1. Formulate sentences and define grade level vocabulary (roamed, completed,natural, wildlife) with slp model/cue. 2. Play irregular verbs bingo with slp cue while formulating sentences.3. Formulate and defing grade level vocabulary (roamed, completed, natural,wildlife) with slp model/cue4. Formulate sentences with grade level vocabulary while playing irregular verbs"irregular verb bingo" with slp model/cue as needed.

Goal Progress: PROGRESS, PROGRESS, PROGRESS, PROGRESSDefined grade level vocabulary 4/7, idioms, word of the week with minimalslp cue. Identified main idea of board without slp cue. Formulated sentneceswith irregular verbs with 90% accuracy and minimal slp cue.

09/21/201103

10:00 AM -10:30 AM

92508 TM 1. Intoduce, define, draw pictures for grade level vocabulary (endless, universe,protested, realistic, sensible astronaut, paralyzed) with slp model/cue. Introduceinferencing with slp scaffolding and modeling2. Intoduce, define, draw pictures for grade level vocabulary (endless, universe,protested, realistic, sensible astronaut, paralyzed) with slp model/cue. Introduceinferencing with slp scaffolding and modeling.3. Introduce inferencing with slp scaffolding and modeling4. Introduce and formulate complex sentences with slp model/cue using categoryboard.

Goal Progress: PROGRESS, PROGRESS, PROGRESS, PROGRESSIdentified converstion starter with slp cue. Needed cues for exchange.Introduced, defined, and gave examples for class ideiom, category, word,and vocabulary with slp model/cue. no data. Introduced inferencing with slpmodel/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 1 of 2

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/28/201103

10:00 AM -10:30 AM

92508 TM 1. Intoduce, define, draw pictures for grade level vocabulary (endless, universe,protested, realistic, sensible astronaut, paralyzed) with slp model/cue. Introduceinferencing with slp scaffolding and modeling2. Intoduce, define, draw pictures for grade level vocabulary (endless, universe,protested, realistic, sensible astronaut, paralyzed) with slp model/cue. Introduceinferencing with slp scaffolding and modeling.3. Introduce inferencing with slp scaffolding and modeling4. Introduce and formulate complex sentences with slp model/cue using categoryboard.

Goal Progress: PROGRESS, PROGRESS, PROGRESS, PROGRESSIntroduced grade level vocabulary, idioms, category, word of the week withcontext clues, synonyms, and antonyms with slp model/cue. 2/6. Answeredinference questions with slp model/cue.

09/30/201103

10:00 AM -10:30 AM

92508 TM 1. Define grade level vocabulary (endless, universe, protested, realistic, sensibleastronaut, paralyzed) with slp model/cue. Introduce inferencing with slp scaffoldingand modeling2. Define and formulate sentences for grade level vocabulary (endless, universe,protested, realistic, sensible astronaut, paralyzed) with slp model/cue. Introduceinferencing with slp scaffolding and modeling.3. Make infrences with slp scaffolding and modeling using inferencing cards.4. Formulate complex sentences with slp model/cue using category board.

Goal Progress: PROGRESS, PROGRESS, PROGRESS, PROGRESSDefined grade level vocabulary, idiom, word of the week 5/7 without slp cue.Answered comprehension question (inference) with slp cues 6/10. Playedgame using irregular verbs 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

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539, 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/01/201103

09:00 AM -09:30 AM

92508 TM 1. Produce vocalic /r/ and /r/ in all positions of words in words, phrases, sentences,and conversation.2. Define, draw pictures, and write sentences for grade level vocabulary/idioms withslp cue as needed.

Goal Progress: GOAL MET, PROGRESSProduced /r/ and vocalic /r/ in conversation with 80% accuracy. Definedgrade level vocabulary 7/10 without cue. Identified synonyms for vocabulary5/10, identified antonyms for vocabulary with slp model/cue.

09/08/201103

09:00 AM -09:40 AM

92508 TM 1. Produce vocalic /r/ and /r/ in all positions of words in words, phrases, sentences,and conversation.2. Define and formulate, and write compound sentences (compound sentenceworksheet) with grade level vocabulary with slp visual/verbal cue. (quest, settings,reduce, buffet, major).3. Compare and contrast items with slp visual/verbal cue.4. Identify main idea while playing game with slp model/cue as needed.

Goal Progress: PROGRESS, NO PROGRESS, PROGRESS, PROGRESSProduced /r/ and vocalic /r/ in conversation with 80% accuracy. Identifiedmain idea/details for category of the week (insects) with slp model/cue.Played "granny's candies" with synonyms 15/20, and similarities (mainidea) 6/9 with slp cue.

09/12/201103

09:00 AM -09:30 AM

92508 TM 1. Produce /r/ and vocalic /r/ in conversation and sentences with minimal to no slpcues.2. Introduce, define, draw pictures, and write sentences for grade levelvocabulary/idioms with slp model/cue. Used vocabulary to answer questions aboutweek day/school with slp model/cue.3. Identified main idea and details when looking at a picture with slp model/cue.Answered main idea questions with slp model/cue.

Goal Progress: MINIMAL PROGRESS, PROGRESS, PROGRESSProduced /r/ and vocalic /r/ in conversation with 70% with slp cue. Identifiedmain idea/details with 10/10 and answered questions to grade level storywith slp cue. 5/5. Formulated compound sentences with grade levelvocabulary with slp model/cue. Answered questions about week usingappropriate verb tense 6/11 with slp cue.

09/14/201103

09:00 AM -09:40 AM

92508 TM 1. Produce vocalic /r/ and /r/ in all positions of words in words, phrases, sentences,and conversation.2. Define and formulate, and write compound sentences (compound sentenceworksheet) with grade level vocabulary with slp visual/verbal cue. (quest, settings,reduce, buffet, major).3. Compare and contrast items with slp visual/verbal cue.4. Identify main idea while playing game with slp model/cue as needed.

Goal Progress: PROGRESS, PROGRESS, NO PROGRESS, PROGRESSProduced vocalic /r/ in conversation with 50%. Able to correct with cues.Reviewed idiom, word, and category of the week with slp model/cue 2/3.Identifed the main idea when looking at pictures and told why something wasnot main idea 5/6 without slp cue. Answered questions in completesentences using regular past tense verbs (ed) with slp cue 14/20.

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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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539, 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/19/201103

09:00 AM -09:30 AM

92508 TM 1. Produce /r/ and vocalic /r/ in conversation and sentences with minimal to no slpcues.2. Introduce, define grade level vocabulary/idioms (mammals, "I smell a rat",antonym) with slp model/cue. 3. Introduce, model, and scaffold using context cues with slp model/cue.Identify/compare things you say to adult vs. peer after a weekend with slpvisual/verbal cue.4. Answer questions using past tense (ed)/irregular verbs with slp visual/verbal cueas needed.

Goal Progress: PROGRESS, PROGRESS, PROGRESS, PROGRESSProduced /r/ and vocalic /r/ in conversation with 80% accuracy.Compared/contrasted, and role played things you say to adults vs. peerswith slp model cue (no data). Answered questions with appropriate verbtense/organization 8/10 with slp cue. Completed and wrote compoundsentences 100% accuracy using conjunction (and). Introduced using contextcues to identify word meaning (no data).

09/21/201103

09:00 AM -09:30 AM

92508 TM 1. Produce /r/ and vocalic /r/ in conversation and sentences with minimal to no slpcues.2. Define, use, sort grade level vocabulary/idioms (mammals, "I smell a rat",antonym) with slp model/cue. 3. Identify word meanings using context cues with slp model/cue. Identify/comparethings you say to adult vs. peer after a weekend with slp visual/verbal cue.4. Answer questions using past tense (ed)/irregular verbs with slp visual/verbal cueas needed while playing grammer board game.

Goal Progress: GOAL MET, PROGRESS, PROGRESS, PROGRESSProduced /r/ and voalic /r/ with 100% accuracy in conversation. Identifiedword meanings using context of story 2/2 with slp cue. Formulatedcompound sentences with conjunction 2/2 with slp cue.

09/28/201103

09:00 AM -09:30 AM

92508 TM 1. Produce /r/ and vocalic /r/ in conversation and sentences with minimal to no slpcues.2. Define and use grade level vocabulary/idioms, word of the week. Use context toanswer to define grade level vocabulary with slp model/cue. Identify mainidea/details for writing assignment with slp model/cue.3. Play irregular verb bingo using correct organization/compound sentencxes whileusing visual/verbal cue as needed.4. Use context to answer to define grade level vocabulary with slp model/cue.Comprehend social situation by identifying things you say to peers in the fall with slpvisual/verbal cue as needed.

Goal Progress: PROGRESS, PROGRESS, PROGRESS, PROGRESSProduced vocalic /r/ and /r/ in conversation with 80% accuracy. Introduced,defined, and used grade level work/vocabulary/idiom with slp model/cue 2/3.Identified details for paper (Describing Mom) with slp cues 2/5. Usedappropriate verb tense when talking about weekend with slp cue. Herequired cues to reciprocate conversation and make relevant statement withslp 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

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/01/201103

11:00 AM -11:20 AM

92508 TM 1. Produce /k/, /g/, /s/ blends, /v/, and /s/ in words, phrases, and sentences. Goal Progress: PROGRESS/s/ in words with slp cue as needed. When aware of tongue protrustion ableto control it.

09/07/201103

11:00 AM -11:20 AM

92508 TM 1. Produce /k/, /g/, /s/ blends, /v/, and /s/ in words, phrases, and sentences. Goal Progress: PROGRESS[Goal 1: 70]Produced /s/ in words and phrases and conversation with slp model/cue asneeded 418.

09/08/201103

11:00 AM -11:20 AM

92508 TM 1. Produce /k/, /g/, /s/ blends, /v/, and /s/ in words, phrases, and sentences. Goal Progress: PROGRESS[Goal 1: 90]/s/ in words, phrases, sentences with slp cue as needed. 200x

09/12/201103

11:00 AM -11:20 AM

92508 TM 1. Take baseline data on /k/, /g/, /s/ blends, /v/, and /s/ in words, phrases, andsentences.

Goal Progress: PROGRESS[Goal 1: 80]/s/ in words, phrases, and sentences with slp cue.

09/14/201103

11:00 AM -11:20 AM

92508 TM 1. Tested /k/, /g/, /s/ blends, /v/, and /s/ in words, phrases, and sentences. Goal Progress: PROGRESS[Goal 1: 50]/s/ in words, phrases, and sentences without slp cue. 23/34/s/ medial in conversations 4/20

09/15/201103

11:00 AM -11:20 AM

92508 TM 1. Produce /k/, /g/, /s/ blends, /v/, and /s/ in words, phrases, and sentences. Goal Progress: PROGRESS[Goal 1: 76]/s/ in sentences with slp model.

09/19/201103

11:00 AM -11:20 AM

92508 TM 1. Take baseline data on /k/, /g/, /s/ blends, /v/, and /s/ in words, phrases, andsentences.

Goal Progress: PROGRESSProduced /s/ in words with (tongue in) with 80% accuracy.

09/21/201103

11:00 AM -11:20 AM

92508 TM 1. Tested /k/, /g/, /s/ blends, /v/, and /s/ in words, phrases, and sentences. Goal Progress: PROGRESS[Goal 1: 100%, Goal 1: 100%]/s/ in words, phrases, sentences with slp cue as needed. 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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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/26/201103

11:00 AM -11:20 AM

92508 TM 1. Take baseline data on /k/, /g/, /s/ blends, /v/, and /s/ in words, phrases, andsentences.

Goal Progress: PROGRESS/s/ in words without slp cue (keeping tongue in) 50%.

09/29/201103

11:00 AM -11:20 AM

92508 TM 1. Produce /k/, /g/, /s/ blends, /v/, and /s/ in words, phrases, and sentences. Goal Progress: PROGRESSProduced /s/ in sentences with slp cue/mirror while playing a game with70% 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

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s):Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/01/201103

01:15 PM -01:30 PM

92508 TM 1. Screen and take baseline data on age approrpriate sounds.2. Produce /s/ in words, sentences, and conversation with slp cue/model as neededwhile participating in centers.

Goal Progress: PROGRESS[Goal 1: 50]/s/ shaped with smile in words with model/cue. 100x

09/06/201103

01:15 PM -01:30 PM

92508 TM 1. Produce /s/ in words, phrases, and sentences with slp visual/verbal cue asneeded.

Goal Progress: PROGRESS[Goal 1: 80]shaping /s/ in words with slp model/cue 180x.

09/07/201103

01:15 PM -01:30 PM

92508 TM 1. Produce /s/ in words, phrases, and sentences with slp visual/verbal cue asneeded.

Goal Progress: PROGRESSProduced /s/ in words with slp cue as needed 260. no data

09/08/201103

01:15 PM -01:45 PM

92508 TM 1. Screen and take baseline data on age approrpriate sounds.2. Produce /s/ in words, sentences, and conversation with slp cue/model as neededwhile participating in centers.

Goal Progress: PROGRESS[Goal 1: 80] /s/ in words to target tongue protrusion with slp cue as needed. 300x 8/10with slp cue.

09/13/201103

01:15 PM -01:30 PM

92508 TM 1. Produce /s/ in words, phrases, and sentences with slp visual/verbal cue asneeded.

Goal Progress: PROGRESSProduced /s/ in words with slp cue. 150x. no data.

09/14/201103

01:15 PM -01:30 PM

92508 TM 1. Produce /s/ in words, phrases, and sentences with slp visual/verbal cue asneeded.

Goal Progress: PROGRESS/s/ in phrases with slp cue to keep tongue in. no data.

09/15/201103

01:15 PM -01:45 PM

92508 TM 1. Screen and take baseline data on age approrpriate sounds.2. Produce /s/ in words, sentences, and conversation with slp cue/model as neededwhile participating in centers.

Goal Progress: PROGRESS[Goal 1: 100]/s/ in words with slp cue as needed.

09/19/201103

01:15 PM -01:30 PM

92508 TM 1. Produce /s/ in words, phrases, and sentences with slp visual/verbal cue asneeded.

Goal Progress: PROGRESS[Goal 1: 100]/s/ in words and phrases with minimal slp cue. 200x

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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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s):Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/21/201103

01:15 PM -01:30 PM

92508 TM 1. Shaped /ch/ in words with slp visual/verbal cue as needed. Goal Progress: PROGRESSshaped /ch/ in words from /sh/ with slp model/cue. no data.

09/22/201103

01:15 PM -01:45 PM

92508 TM 1. Produced /ch/ in words with slp model/cue. Goal Progress: PROGRESS/ch/ in words with slp cue as needed 150x.

09/27/201103

01:30 PM -01:45 PM

92508 TM 1. Produce /s/ in words, phrases, and sentences with slp visual/verbal cue asneeded.

Goal Progress: PROGRESShad training

09/28/201103

01:15 PM -01:30 PM

92508 TM 1. Shaped /ch/ in words with slp visual/verbal cue as needed. Goal Progress: PROGRESSPrdoced /s/ in phrases with slp visual/verbal cue 150 with 90%. However inunstructured 20% able to correct with slp cue.

09/29/201103

01:15 PM -01:45 PM

92508 TM 1. Screen and take baseline data on age approrpriate sounds.2. Produce /s/ in words, sentences, and conversation with slp cue/model as neededwhile participating in centers.

Goal Progress: PROGRESS/s/ in word (tongue protrusion) with slp cue as needed 30%.

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

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/01/201103

02:45 PM -03:00 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, sentences, and conversation with slpcue/model as needed while participating in centers.

Goal Progress: PROGRESS[Goal 1: 60]vocalic /r/ in words, phrases with slp cue 100x.

09/07/201103

02:45 PM -03:00 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, phrases, sentences, and conversation with slpvisual/verbal cue as needed.

Goal Progress: PROGRESS[Goal 1: 80]Produced vocalic /r/ in words, phrases, and sentences 170x with slp cue.

09/08/201103

02:45 PM -03:00 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, sentences, and conversation with slpcue/model as needed while participating in centers.

Goal Progress: PROGRESS[Goal 1: 70]vocalic /r/ in words, sentences with slp cue. 150x.

09/12/201103

12:30 PM -12:45 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, phrases, sentences, and conversation with slpvisual/verbal cue as needed.

Goal Progress: PROGRESS[Goal 1: 60]/r/ and vocalic /r/ in words, phrases with slp model/cue 151x.

09/13/201103

12:30 PM -12:45 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, phrases, sentences, and conversation with slpvisual/verbal cue as needed.

Goal Progress: PROGRESSWorked on self monitoring and judging vocalic /r/ in words, phrases,sentences with slp model/cue. 100x

09/14/201103

12:30 PM -12:45 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, phrases, sentences, and conversation with slpvisual/verbal cue as needed.

Goal Progress: PROGRESStested vocalic /r/ in words 51/53. vocaclic /r/ in sentences 14/27.

09/15/201103

12:30 PM -12:45 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, sentences, and conversation with slpcue/model as needed while participating in centers.

Goal Progress: PROGRESS[Goal 1: 98]Produced /r/ in words/sentences/phrases while playing bingo

09/16/201103

12:30 PM -12:45 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, sentences, and conversation with slpcue/model as needed while participating in centers.

Goal Progress: PROGRESS[Goal 1: 83]/r/ initial in words 19/21 without slp cue.vocalic /r/ without 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 1 of 3

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/19/201103

12:30 PM -12:45 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, phrases, sentences, and conversation with slpvisual/verbal cue as needed.

Goal Progress: PROGRESSvocalic /r/ in phrases with slp cue as needed 71% with slp model/cue.

09/20/201103

12:30 PM -12:45 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, phrases, sentences, and conversation with slpvisual/verbal cue as needed.

Goal Progress: PROGRESS/r/ in words 90%. Formulated sentences with /r/ 150x withs slp model/cue.

09/21/201103

12:30 PM -01:00 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, phrases, sentences, and conversation with slpvisual/verbal cue as needed.

Goal Progress: PROGRESS[Goal 1: 70]vocalic /r/ in words, sentences with slp cue as needed. 150x

09/22/201103

12:45 PM -01:00 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, sentences, and conversation with slpcue/model as needed while participating in centers.

Goal Progress: PROGRESSproduced /r/ in sentences with slp cue. 150x.

09/23/201103

12:30 PM -12:45 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, phrases, sentences, and conversation with slpvisual/verbal cue as needed.

Goal Progress: PROGRESSvocalic /r/ in sentences while playing a game with 50% accuracy, able tocorrect with slp cue.

09/26/201103

12:30 PM -12:45 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, phrases, sentences, and conversation with slpvisual/verbal cue as needed.

Goal Progress: PROGRESS/r/ in sentences and words with slp cue as needed 70%.

09/27/201103

12:30 PM -12:45 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, phrases, sentences, and conversation with slpvisual/verbal cue as needed.

Goal Progress: PROGRESSProduced vocalic /r/ in response to questions with slp model/cue 70%.

09/28/201103

12:30 PM -01:00 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, phrases, sentences, and conversation with slpvisual/verbal cue as needed.

Goal Progress: PROGRESSWalked around building and talked to staff using vocalic /r/ 150x. 70%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 3

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/29/201103

02:45 PM -03:00 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, sentences, and conversation with slpcue/model as needed while participating in centers.

Goal Progress: PROGRESSProduced vocalic /r/ while playing a game with sl pcue as needed 60%accuracy.

09/30/201103

12:30 PM -12:45 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, phrases, sentences, and conversation with slpvisual/verbal cue as needed.

Goal Progress: PROGRESSProduced vocalic /r/ while playing a game in sentences with slp cue asneeded 70% able to correct with 100%.

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 3 of 3

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/01/201103

12:00 PM -12:15 PM

92508 TM 1. Produce /s/ blends in words, phrases, and sentences while participating in centerswith slp visual/verbal cue as needed.

Goal Progress: PROGRESS[Goal 1: 50]/st/ in phrases, sentences with slp cue/model. 150x

09/02/201103

12:00 PM -12:15 PM

92508 TM 1. Produce /s/ blends in words, phrases, and sentences while participating in centerswith slp visual/verbal cue as needed.

Goal Progress: PROGRESS[Goal 1: 70]Produced /s/ blends in words/phrases with slp cue as needed. 117x

09/06/201103

12:00 PM -12:15 PM

92508 TM 1. Take baseline data for sounds: Goal Progress: PROGRESSProduced /s/ blends in words 90%, sentences with cue 80%. 162x

09/07/201103

12:00 PM -12:15 PM

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

Goal Progress: PROGRESSProduced /sw/ in words with slp cue 315x. no data.

09/08/201103

12:00 PM -12:30 PM

92508 TM 1. Produce final consonants in words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESS[Goal 1: 80]/sw/ in words and phrases with slp cue as needed 200x

09/12/201103

12:00 PM -12:15 PM

92508 TM 1. Produce /s/ blends in words, phrases, and sentences while participating in centerswith slp visual/verbal cue as needed.

Goal Progress: PROGRESS[Goal 1: 80]Produced /sw/ in phrases with slp model/cue 150x

09/13/201103

12:00 PM -12:15 PM

92508 TM 1. Take baseline data for sounds: Goal Progress: PROGRESS[Goal 1: 60]/sw/ in sentences with slp cue/model as needed 151x.

09/14/201103

12:00 PM -12:15 PM

92508 TM 1. tested /sw/ and /h/ in words, phrases, and sentences while participating in centerswith slp visual/verbal cue as needed.

Goal Progress: PROGRESS/sw/ in words 8/10, phrases, sentences /h/ word 10/10, sentences 6/10

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 3

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/15/201103

12:00 PM -12:30 PM

92508 TM 1. Tested multisyllable words in words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESS2 syllable words in phrases 4/5, sentences 4/7.

09/16/201103

12:00 PM -12:15 PM

92508 TM 1. Produce final consonants in words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESS[Goal 1: 79]/s/ blends in words without slp cue/modle.

09/19/201103

12:00 PM -12:15 PM

92508 TM 1. Baseline data on 2-3 syllable words in words and phrases with slp cue. Goal Progress: PROGRESSMultisyllable words with slp cue as needed 60%.

09/21/201103

12:00 PM -12:15 PM

92508 TM 1. tested //ts/ in words, phrases, and sentences while participating in centers with slpvisual/verbal cue as needed.

Goal Progress: PROGRESS[Goal 1: 40]produced /ts/ in words with slp modle/cue. 150x

09/22/201103

12:00 PM -12:15 PM

92508 TM 1. Produce /ts/ in words, phrases, and sentences while participating in centers withslp visual/verbal cue as needed.

Goal Progress: PROGRESSProduced /ts/ in words withs slp model/cue. no data 300x.

09/23/201103

12:00 PM -12:15 PM

92508 TM 1. Baseline data on 2-3 syllable words in words and phrases with slp cue. Goal Progress: PROGRESSFormulated sentences with slp cue using /s/ blends 80%.

09/26/201103

12:00 PM -12:15 PM

92508 TM 1. Shape /ts/ ending sound in words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESS/ts/ in ending of words with slp model/cue as needed 50%.

09/27/201103

12:00 PM -12:15 PM

92508 TM 1. Take baseline data for sounds: Goal Progress: PROGRESSAnswered questins to work on completing sentences with /s/ blends and /ts/and getting ending sounds with slp model/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 3

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/28/201103

12:00 PM -12:15 PM

92508 TM 1. tested //ts/ in words, phrases, and sentences while participating in centers with slpvisual/verbal cue as needed.

Goal Progress: PROGRESSProduced /ts/ in words 181x with 70% with slp model/cue.

09/29/201103

12:00 PM -12:15 PM

92508 TM 1. Produce final consonants in words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESS/ts/ in words with slp model/cue. 150x 70%. Needs cues to use all sounds insentences.

09/30/201103

12:00 PM -12:15 PM

92508 TM 1. Baseline data on 2-3 syllable words in words and phrases with slp cue. Goal Progress: PROGRESSPlayed game producing /s/ blends, /ts/ in sentences in sentences. 80%. Haddifficulty with multisyllable words and ending sounds in unstructured sounds.

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 3 of 3

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/01/201103

12:00 PM -12:15 PM

92508 TM 1. Shape /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESS/s/ in conversation 300x no data.

09/02/201103

12:00 PM -12:15 PM

92508 TM Goal Progress: Produced /s/ in words and phrases/sentences with slp cue as needed to keeptongue in. 120x. 15/20. He is aware in structured sentences.

09/06/201103

12:00 PM -12:15 PM

92508 TM 1. Shape /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESSProduced /s/ in words/phrases targeting keeping tongue in with slp cue 250x.

09/07/201103

12:00 PM -12:15 PM

92508 TM 1. Shape /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESS/s/ in words and phrases with slp cue 300x. no data.

09/08/201103

12:00 PM -12:30 PM

92508 TM 1. Shape /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESS[Goal 1: 90]/s/ in words and phrases 230x with slp cue as needed.

09/12/201103

12:00 PM -12:15 PM

92508 TM 1. Shape /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESS[Goal 1: 70]/s/ in words, phrases, and sentences with slp cue 150x.

09/13/201103

12:00 PM -12:15 PM

92508 TM 1. Shape /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESSmonitoring /s/ for tongue protrustion with sl cue. no data

09/14/201103

12:00 PM -12:15 PM

92508 TM 1. Tested /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: NO PROGRESSdid not have time to assess.

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 3

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/15/201103

12:00 PM -12:30 PM

92508 TM 1. Shape /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESS/s/ in conversation requires 1-2 slp cues to keep tongue in mouth.

09/19/201103

12:00 PM -12:15 PM

92508 TM 1. Shape /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESSworking on shaping tongue protrusion with slp cue.

09/21/201103

12:00 PM -12:15 PM

92508 TM 1. Tested /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: GOAL METshaping /s/ for tongue protrusion. no data

09/22/201103

12:00 PM -12:15 PM

92508 TM 1. Shape /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESSshaped /s/ working on keeping tongue in mouth with slp model/cue.

09/23/201103

12:00 PM -12:15 PM

92508 TM 1. Shape /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESSFormulated sentences with /s/ blends with slp cue. 90%.

09/26/201103

12:00 PM -12:15 PM

92508 TM 1. Shape /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESS/s/ in words and sentences with slp cue as needed 70%.

09/27/201103

12:00 PM -12:15 PM

92508 TM 1. Shape /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESSAnswered questions to work on generalization of /s/ with slp cue/model.

09/28/201103

12:00 PM -12:15 PM

92508 TM 1. Tested /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESSProduced /s/ in conversation with 60% accuracy and slp model/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 3

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/29/201103

12:00 PM -12:15 PM

92508 TM 1. Shape /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESS/s/ in words with slp cue. 150x working on tongue protrusion.

09/30/201103

12:00 PM -12:15 PM

92508 TM 1. Shape /s/ from /t/ to produce words, phrases, and sentences while participating incenters with slp visual/verbal cue as needed.

Goal Progress: PROGRESS90% in conversation /s/ with slp cue to keep in. Able to correct.

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 3 of 3

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539, 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/02/201103

10:00 AM -10:30 AM

92508 TM 1. Produce /s/ and /s/ clusters in conversation without slp cue.2. Produce and formulate sentences with appropriate regular past tense verb (ed)while playing bingo with slp cue as needed.3. Define grade level vocabulary, synonyms, and idioms with slp model/cue asneeded. Use context clues to identify and answer questions to grade level story withslp model/cue.

Goal Progress: GOAL MET, PROGRESS, PROGRESSIdentified and formulated sentences with regular past tnese verbs (ed) 20/20.Defined vocabulary 6/7. Identified synonyms 4/4 without slp cue. Definedidiom of the week (wrong side of the bed) with slp model/cue, word of theweek, and category of the week) 2/3. Focused on context cues to answerwh-questions to story, needed slp cue to point them out.

09/07/201103

10:00 AM -10:30 AM

92508 TM 1. Take baseline data for /s/ and /s/ clusters.2. Intoduce, define, draw pictures for grade level vocabulary (shimmer, eerie,swallows, lurk, climate, silken, and lumbering) with slp model/cue. Answer wh-questions to grade level story using context cues, with slp model/cue. Introduce mainidea of story

Goal Progress: PROGRESS, PROGRESSIntroduced and defined grade level vocabulary with synonyms with slpmodel/cue and context 4/8. Identified main idea vs. details when given apicture. 5/6.

09/14/201103

10:00 AM -10:30 AM

92508 TM 1. Produce /s/ and /s/ clusters in words, phrases, and sentences with minimal slpcueing.2. Intoduce, define, draw pictures for grade level vocabulary (roamed, completed,natural, wildlife) with slp model/cue. Answer about main idea with slp scaffolding andmodeling.

Goal Progress: PROGRESS, PROGRESSIntroduced defined, and formulated sentences for class vocabualry 2/5.Identified main idea and details for category of the week (solarsystem/space).

09/16/201103

09:45 AM -10:15 AM

92508 TM 1. Produce /s/ and /s/ blends in conversation with slp model/cue as needed. Goal Progress: GOAL METproduced /s/ and /s/ blends in sentences with 100% accuracy.

09/16/201103

10:00 AM -10:30 AM

92508 TM 1. Formulate sentences with grade level vocabulary while playing irregular verbs"Grannies Candies" with slp model/cue as needed. Identify main idea, define weeklyidiom/word of the week.2. Formulate sentences and define grade level vocabulary (roamed, completed,natural, wildlife) with slp model/cue. .

Goal Progress: PROGRESS, PROGRESSDefined grade level vocabulary 5/7, idioms, word of the week with minimalslp cue. Identified main idea of board without slp cue. Formulated sentneceswith irregular verbs with 100% accuracy and minimal slp cue.

09/21/201103

10:00 AM -10:30 AM

92508 TM 1. Produce /s/ and /s/ clusters in words, phrases, and sentences with minimal slpcueing.2. Intoduce, define, draw pictures for grade level vocabulary (endless, universe,protested, realistic, sensible astronaut, paralyzed) with slp model/cue. Introduceinferencing with slp scaffolding and modeling.3. Introduce and formulate complex sentences with slp model/cue using categoryboard.

Goal Progress: PROGRESS, PROGRESS, PROGRESSIdentified converstion starter with slp cue. Needed cues for exchange.Introduced, defined, and gave examples for class ideiom, category, word,and vocabulary with slp model/cue. no data. Introduced inferencing with slpmodel/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 1 of 2

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539, 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/23/201103

09:45 AM -10:15 AM

92508 TM 1. Produce /s/ and /s/ blends in conversation with slp model/cue as needed. Goal Progress: GOAL MET100% in conversation.

09/23/201103

10:00 AM -10:30 AM

92508 TM 1. Define grade level vocabulary (endless, universe, protested, realistic, sensibleastronaut, paralyzed) with slp model/cue. Introduce inferencing with slp scaffoldingand modeling.2. Formulate complex sentences with slp model/cue using category board.

Goal Progress: PROGRESS, PROGRESSDefined and used grade level vocabulary with slp cue 3/6. Answeredquestions about grade level text using inferencing skills with slp cues 1/2.

09/28/201103

10:00 AM -10:30 AM

92508 TM 1. Produce /s/ and /s/ clusters in words, phrases, and sentences with minimal slpcueing.2. Intoduce, define, draw pictures for grade level vocabulary (endless, universe,protested, realistic, sensible astronaut, paralyzed) with slp model/cue. Introduceinferencing with slp scaffolding and modeling.3. Introduce and formulate complex sentences with slp model/cue using categoryboard.

Goal Progress: PROGRESS, PROGRESS, PROGRESSIntroduced grade level vocabulary, idioms, category, word of the week withcontext clues, synonyms, and antonyms with slp model/cue. 3/6. Answeredinference questions with slp model/cue.

09/30/201103

09:45 AM -10:15 AM

92508 TM 1. Produce /s/ and /s/ blends in conversation with slp model/cue as needed. Goal Progress: GOAL MET100% in conversation.

09/30/201103

10:00 AM -10:30 AM

92508 TM 1. Define grade level vocabulary (endless, universe, protested, realistic, sensibleastronaut, paralyzed) with slp model/cue. Introduce inferencing with slp scaffoldingand modeling.2. Formulate complex sentences with slp model/cue using category board.

Goal Progress: PROGRESS, PROGRESSDefined grade level vocabulary, idiom, word of the week 6/7 without slp cue.Answered comprehension question (inference) with slp cues 7/10. Playedgame using irregular verbs 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

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s):Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/06/201103

10:30 AM -11:00 AM

92508 TM 1. Color, label, give function and follow directions with animal book.2. Request and use sentences while playing with "toys" with slp model/cue.3. Imitate and model words with final consonants with slp model/cue.

Goal Progress: PROGRESS, PROGRESS, PROGRESSImitated and read story about ball/toys. Pointed to and repeated objects withslp cue 5/8. Followed directions with slp model for big/small with whiteboard. Described opposite pictures from antonym puzzle with slpmodel/cue. Sentences were 3-5 with slp model.

09/07/201103

10:30 AM -11:00 AM

92508 TM 1. Imitate sentences describing actions and functions of body parts and people whileplaying "Verb Bingo". 2. Follow directions with big/little with slp model/cue. Identify body parts andfunctions with slp cue. Answer yes/no questions with slp cue.

Goal Progress: PROGRESS, PROGRESSPlayed, described and requested Toy Food using "Can I Have the_______,please", "What is it", Answering yes/no questions, and categorizing andsorting toys with slp model/cue. Identified items that are large/small with slpcue 7/10.

09/12/201103

10:30 AM -11:00 AM

92508 TM 1. Identified actions/objects with picture/slp cue while playing "bingo" 9/20.2. .3. Answered yes/no questions with slp cue about picture/toys with slp cue.4. Imitate pronoun + verb+ ing when playing "bingo" with slp model/cu.

Goal Progress: PROGRESS, PROGRESS, PROGRESSAnswered yes/no questions 10/16 with slp cue. Imitated/described actions in"bingo" with slp model. no data.

09/13/201103

10:30 AM -11:00 AM

92508 TM 1. Read book on baseball and identify parts, objects, and actions with slp model/cue.2. Request and use sentences while playing with "toys" with slp model/cue.Describe actions while playing game "ants in the pants".3. Answer yes/no questions about book with slp model/cue.

Goal Progress: PROGRESS, PROGRESS, PROGRESSImitated phrases he/she/they are playing while looking at "sports" book.Identified feelings, actions, objects from baseball book with slp model/cue.

09/14/201103

10:30 AM -11:00 AM

92508 TM 1. Imitate sentences describing actions and functions of body parts and people.Follow directions with big/little. Point to picture upon request with slp model/cue. 2. Follow directions with big/little with slp model/cue. Identify body parts andfunctions with slp cue. Use 3-5 word sentences to request toy food with slpmodel/cue.

Goal Progress: PROGRESS, PROGRESSRead book about sports and described function and parts with slp model/cueto increase sentence. Sorted items by large/small with slp cue 8/14.Imitated/modeled sentences "Can I have the _______" with slp cue.Answered yes/no questions 5/5 with slp cue.

09/15/201103

10:30 AM -11:00 AM

92508 TM 1. Read book about toys with slp/model cue and answer simple wh-questions. Readbook about opposites and answer questions with slp cue. Play wh-bingo with slpmodel/cue.2. Imitate and produce sentences describing actions in book and bingo game with slpmodel/cue.

Goal Progress: PROGRESS, PROGRESSDescribed actions and people in opposite book with slp model/cue using 3-6word phrases. Played "who" bingo to describe person and their action withslp model 8/10.

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 3

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s):Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/19/201103

10:30 AM -11:00 AM

92508 TM 1. Sorted items based on big/little, large small with slp visual/verbal cue.Categorized toys with slp model/cue and described functions with objects with slpcue.2. .3. Answered yes/no questions with slp cue about picture/toys with slp cue.4. Imitated words with /c/ (can) with slp model/cue.

Goal Progress: PROGRESS, PROGRESS, PROGRESSSorted items by size 9/12 with slp cue. Described function of toys with slpvisual/vue 7/10. imitated (k initial) with slp model 90%.

09/21/201103

10:30 AM -11:00 AM

92508 TM 1. Imitate sentences describing actions and functions of body parts and people.Follow directions with big/little. Point to picture upon request with slp model/cue.

Goal Progress: PROGRESSPlayed with a ball, described actions, functions, requested, stated with slpmodel/cue. Played game while describing people and actions with slpmodel/cue "he is _________" with slp modle/cue.

09/22/201103

10:30 AM -11:00 AM

92508 TM 1. Play Pizza game working on requesting in 3-5 word phrases "Can I have a______" with slp model/cue. Describe sequence cards actions in each card with slpmodel/cue.2. Imitate and produce words with /k/ initial in words/phrases with slp model/cue.

Goal Progress: PROGRESS, PROGRESSImitated requesting "can I have ______" with slp model/cue 15x whenplaying pizza game. Identified actions and described in 2-3 word phraseswith slp model/cue 8/14.

09/26/201103

10:30 AM -11:00 AM

92508 TM 1. Tested goals for IEP.2. .3. Answered yes/no questions with slp cue about picture/toys with slp cue. Testedgoals for IEP.4. Imitate pronoun + verb+ ing when playing "bingo" with Tested goals for IEP.slpmodel/cu.

Goal Progress: PROGRESS, PROGRESS, PROGRESSfinal consonants in words without model 50%, with model 80%. Uses 2-5word sentences verb+ing with model 70%, pronoun 0% without model.

09/27/201103

10:30 AM -11:00 AM

92508 TM 1. Described pictures with pronoun + verb + ing with slp model/cue.2. Answer wh-questions to story with slp model/cue.3. Answer yes/no questions about book with slp model/cue.

Goal Progress: PROGRESS, PROGRESS, PROGRESSProduced /f/ in words with slp model/cue 0%. Imitated 'she" is verb+ing with slp model 60%, without slp model 0%.Answer simple what question 70%.

09/28/201103

10:30 AM -11:00 AM

92508 TM 1. Formulate phrases/describe pictures with "he/she is verb+ing" with slpmodel/cue. 2. Follow directions while playing "hear builder" with next/beside with slp model/cue.3. Introduce and read book about "food" with slp model/cue.

Goal Progress: PROGRESS, PROGRESS, PROGRESSDescribed pictures with "she is verb+ing" with slp model/cue 50%.Followed directions with beside/next while playing "Hearbuilder" with 50%accuracy. Read book about "sandwiches" followed directions andcategorized, described foods 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 2 of 3

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s):Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/29/201103

10:30 AM -11:00 AM

92508 TM 1. Read book about toys with slp/model cue and answer simple wh-questions.Introduce "big/little" with toys with slp model/cue. Play Hear Builder followingdirections with slp model/cue.2. Imitate and produce words with final consonants while playing game with slpmodel/cue.

Goal Progress: PROGRESS, PROGRESSSorted and categorized food while reading a book. Followed directions withnext/beside with slp cue 6/10. Pointed and imitated "she is verb+ing" with slpcue 6/10.

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 3 of 3

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/01/201103

11:00 AM -11:20 AM

92508 TM 1. produce /k/, /g/, and /s/ in words, phrases, and sentences. Goal Progress: PROGRESS[Goal 1: 20]/sk/ in isolation and words with slp cue to slow down and tactile cue. 100x

09/07/201103

11:00 AM -11:20 AM

92508 TM 1. produce /k/, /g/, and /s/ in words, phrases, and sentences. Goal Progress: PROGRESSProduced /sk/ blends in words with slp model/cue as needed 226x. no data.

09/08/201103

11:00 AM -11:30 AM

92508 TM 1. produce /k/, /g/, and /s/ in words, phrases, and sentences. Goal Progress: PROGRESS[Goal 1: 80]/sk/ in words with slp cue as needed 250x.

09/12/201103

11:00 AM -11:20 AM

92508 TM 1. Take baseline data on /k/, /g/, and /s/ in words, phrases, and sentences. Goal Progress: PROGRESS[Goal 1: 90]/sk/ blends in words and phrases with slp model/cue 200x.

09/15/201103

11:00 AM -11:20 AM

92508 TM 1. produce /k/, /g/, and /s/ in words, phrases, and sentences. Goal Progress: PROGRESS[Goal 1: 96]tested /s/ blends in words with slp model.

09/19/201103

11:00 AM -11:20 AM

92508 TM 1. Take baseline data on /k/, /g/, and /s/ in words, phrases, and sentences. Goal Progress: PROGRESSProduced /sk/ in words with 80% accuracy without slp cue.

09/21/201103

11:00 AM -11:20 AM

92508 TM 1. tested /k/, /g/, and /s/ in words, phrases, and sentences. Goal Progress: PROGRESS[Goal 1: 100]/sk/ blends in words, phrases, sentences with slp cue as needed. 166x

09/26/201103

11:00 AM -11:20 AM

92508 TM 1. Take baseline data on /k/, /g/, and /s/ in words, phrases, and sentences. Goal Progress: PROGRESS/sk/ in sentences with other /s/ blends 100% without 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 1 of 2

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/29/201103

11:00 AM -11:20 AM

92508 TM 1. produce /k/, /g/, and /s/ in words, phrases, and sentences. Goal Progress: PROGRESS/s/ blends 90% in conversation, words, and sentences with minimal slp cue./sh/ and /ch/ sound a little slushy.

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

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/02/201103

10:00 AM -10:30 AM

92508 TM 1. Take baseline data.2. Produce and formulate sentences with appropriate regular past tense verb (ed)while playing bingo with slp cue as needed.

Goal Progress: PROGRESS, PROGRESSIdentified and formulated sentences with regular past tnese verbs (ed) 20/20.Defined vocabulary 7/7. Identified synonyms 4/4 without slp cue. Definedidiom of the week (wrong side of the bed) with slp model/cue, word of theweek, and category of the week) 1/3. Focused on context cues to answerwh-questions to story, needed slp cue to point them out.

09/06/201103

10:00 AM -10:30 AM

92508 TM 1. Formulate sentnces with grade level vocabulary (shimmer, eerie, swallows, lurk,climate, silken, lumbering) with appropriate verb tense with slp model/cue.2. Introduce, answer/ask, and follow directions about main idea/details with slpmodel/cue.

Goal Progress: PROGRESS, PROGRESSIntroduced vocabulary from class with slp model/cue (shimmer, eerie,silken, lumbering, swallow, lurk, climate with slp visual/verbal cue.Formulated grammatically correct sentences with slp model 3/8.

09/07/201103

10:00 AM -10:30 AM

92508 TM 1. Intoduce, define, draw pictures for grade level vocabulary (shimmer, eerie,swallows, lurk, climate, silken, and lumbering) with slp model/cue. Answer wh-questions to grade level story using context cues, with slp model/cue. Introduce mainidea of story

Goal Progress: PROGRESSIntroduced and defined grade level vocabulary with synonyms with slpmodel/cue and context 6/8. Identified main idea vs. details when given apicture. 2/6.

09/13/201103

10:00 AM -10:30 AM

92508 TM 1. Intoduce, define, draw pictures for grade level vocabulary (roamed, completed,natural, wildlife) with slp model/cue. Follow directions while playing earobics withslp model/cue.2. Introduce, answer/ask, and follow directions about main idea/details with slpmodel/cue.

Goal Progress: PROGRESS, PROGRESSIntroduced grade level vocabulary, category, idiom with slp model cue usingcontext and examples. (2/5) Identified main idea/details with slp model/cue.3/8.

09/14/201103

10:00 AM -10:30 AM

92508 TM 1. Intoduce, define, draw pictures for grade level vocabulary (roamed, completed,natural, wildlife) with slp model/cue. Answer questions about main idea and identifythe details with slp scaffolding and modeling.

Goal Progress: PROGRESSIntroduced defined, and formulated sentences for class vocabualry 3/5.Identified main idea and details for category of the week (solarsystem/space).

09/16/201103

10:00 AM -10:30 AM

92508 TM 1. Formulate and define grade level vocabulary (roamed, completed, natural,wildlife) with slp model/cues. Formulate sentences with grade level vocabularywhile playing irregular verbs "irregular verb bingo" with slp model/cue as needed.

Goal Progress: PROGRESSDefined grade level vocabulary 5/7, idioms, word of the week with minimalslp cue. Identified main idea of board without slp cue. Formulated sentneceswith irregular verbs with 80% accuracy and minimal slp cue.

09/21/201103

10:00 AM -10:30 AM

92508 TM 1. Intoduce, define, draw pictures for grade level vocabulary (endless, universe,protested, realistic, sensible astronaut, paralyzed) with slp model/cue. Introduceinferencing with slp scaffolding and modeling2. Introduce and formulate complex sentences with slp model/cue using categoryboard.

Goal Progress: PROGRESS, PROGRESSIdentified converstion starter with slp cue. Needed cues for exchange.Introduced, defined, and gave examples for class ideiom, category, word,and vocabulary with slp model/cue. no data. Introduced inferencing with slpmodel/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 1 of 2

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/23/201103

10:00 AM -10:30 AM

92508 TM 1. Define grade level vocabulary (endless, universe, protested, realistic, sensibleastronaut, paralyzed) with slp model/cue. Introduce inferencing with slp scaffoldingand modeling2. Formulate complex sentences with slp model/cue using category board.

Goal Progress: PROGRESS, PROGRESSDefined and used grade level vocabulary with slp cue 3/6. Answeredquestions about grade level text using inferencing skills with slp cues 1/2.

09/27/201103

10:00 AM -10:30 AM

92508 TM 1. Intoduce, define, draw pictures for grade level vocabulary (roamedendless,universe, protested, realisstic, sensible, astronaut, paralyzed) with slp model/cue.Follow directions while playing earobics with slp model/cue.

Goal Progress: PROGRESSIntroduced grade level vocabulary with slp model/cue 4/6. Identifiedsynonyms and antonyms. Introduced using context of story to answerquestions to the story with slp model/cue.

09/28/201103

10:00 AM -10:30 AM

92508 TM 1. Intoduce, define, draw pictures for grade level vocabulary (endless, universe,protested, realistic, sensible astronaut, paralyzed) with slp model/cue. Introduceinferencing with slp scaffolding and modeling2. Introduce and formulate complex sentences with slp model/cue using categoryboard.

Goal Progress: PROGRESS, PROGRESSIntroduced grade level vocabulary, idioms, category, word of the week withcontext clues, synonyms, and antonyms with slp model/cue. 5/6. Answeredinference questions with slp model/cue.

09/30/201103

10:00 AM -10:30 AM

92508 TM 1. Define grade level vocabulary (endless, universe, protested, realistic, sensibleastronaut, paralyzed) with slp model/cue. Introduce inferencing with slp scaffoldingand modeling2. Formulate complex sentences with slp model/cue using category board.

Goal Progress: PROGRESS, PROGRESSDefined grade level vocabulary, idiom, word of the week 6/7 without slp cue.Answered comprehension question (inference) with slp cues 6/10. Playedgame using irregular verbs 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

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s):Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/01/201103

02:45 PM -03:00 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, sentences, and conversation with slpcue/model as needed while participating in centers.

Goal Progress: GOAL MET100% in conversation

09/06/201103

02:45 PM -03:00 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, phrases, sentences, and conversation with slpvisual/verbal cue as needed.

Goal Progress: GOAL MET100% in conversation without slp cue.

09/08/201103

02:45 PM -03:00 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, sentences, and conversation with slpcue/model as needed while participating in centers.

Goal Progress: GOAL MET/r/ and vocalic /r/ 100% in conversation.

09/13/201103

12:30 PM -12:45 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, phrases, sentences, and conversation with slpvisual/verbal cue as needed.

Goal Progress: GOAL MET100% /r/ and vocalic /r/ in coversation.

09/14/201103

12:30 PM -01:00 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, phrases, sentences, and conversation with slpvisual/verbal cue as needed.

Goal Progress: GOAL MET100% in conversation.

09/15/201103

12:30 PM -12:45 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, sentences, and conversation with slpcue/model as needed while participating in centers.

Goal Progress: GOAL METmet goal able to produce /r/ in conversation with 100% accuracy.

09/16/201103

12:30 PM -12:45 PM

92508 TM 1. Produce /r/ and vocalic /r/ in words, sentences, and conversation with slpcue/model as needed while participating in centers.

Goal Progress: GOAL MET100% in conversation without 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 1 of 1

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): , 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/02/201103

07:50 AM -07:50 AM

92508 TM 1. Read "Brennan's Bonfire" and answered wh-questions with slp visual cue. 2. Identified and defined vocabulary, associations for (hayride, bonfire, scarecrow,straw/hay, crow, harvest moon). Introduced and identified "word of the week"synonyms" with slp visual/cue. Reviewed "category of the week" occupations withOccupation Bi

Goal Progress: PROGRESS, PROGRESSIdentified synonyms to story with slp cue 5/10. Answered wh-questions tostory 9/10 with slp visual/cue. Used sentence cue to identify occupation inoccupation Bingo. 15/20.

09/06/201103

01:50 PM -02:20 PM

92508 TM 1. Review "September Vocabulary", word/category/idiom (synonyms, insects, shakea leg) of week.2. Answer questions to Brennan's Bonfire story and follow directions with vocabulary.3. Formulate and write sentences with regular past tense verbs (ed). Play verb (ed)game with slp visual/verbal cue.

Goal Progress: PROGRESS, PROGRESS, PROGRESSReviewed story from "Brennan's Hayride". Identified synonyms and defined(hayride, mare, scarecrow, straw, crow, wagon) 6/8. Followed directionswith concepts in front/behind/over/next 5/7.

09/13/201103

07:50 AM -07:50 AM

92508 TM 1. Introduce category of the week and discuss with slp model/cue (space and solarsystem). 2. Play irregular verb tense bingo with slp model/cue.

Goal Progress: PROGRESS, PROGRESSIdentified "solar system" and items associated with space with slpcue/model. Talked about the planets, moon/luna, and starts. Played irregularverb tense bingo 6/10 and formulated sentences with slp cue.

09/16/201103

01:50 PM -02:20 PM

92508 TM 1. Review word, category, idiom of the week and give examples. Identify the mainidea/details when looking at pictures with slp questions prompts.. Identify how itemsare similiar/different with slp model/cue.

Goal Progress: PROGRESSIdentified main idea with slp questions prompts 3/5. Identified how items aredifferent with slp model 5/8.

09/23/201103

01:50 PM -02:20 PM

92508 TM 1. Review word, category, idiom of the week and give examples. Introduce and readconcept story "Never and Always" and answer questions and follow directions withslp visual/verbal cue. 2. Play past tense bingo (ed) with slp model/cue.3. take baseline data and review class expectations.

Goal Progress: MINIMAL PROGRESS, PROGRESS, PROGRESSSorted and identified category words with slp model/cue related to fall. nodata.

09/30/201103

01:50 PM -02:20 PM

92508 TM 1. Review word, category, idiom of the week and give examples. Introduce and readconcept story "Never and Always" and answer questions and follow directions withslp visual/verbal cue. 2. Play past tense bingo (ed) with slp model/cue.3. take baseline data and review class expectations.

Goal Progress: PROGRESS, PROGRESS, PROGRESSIntroduced grade level vocabulary, idiom, category with slp model Answeredcomprehension 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

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/02/201103

10:30 AM -11:00 AM

92508 TM 1. Take baseline 2. Take baseline data.

Goal Progress: PROGRESS, PROGRESSIdentified and formulated sentences with regular past tnese verbs (ed) 20/20.Defined vocabulary 6/7. Identified synonyms 4/4 without slp cue. Definedidiom of the week (wrong side of the bed) with slp model/cue, word of theweek, and category of the week) 1/3. Focused on context cues to answerwh-questions to story, needed slp cue to point them out. 3/6. Talked aboutweekend and (Labor Day) with topic maintainance, required slp cue tomaintain and keep eye contact.

09/07/201103

10:30 AM -11:00 AM

92508 TM 1. Take baseline 2. Take baseline data.

Goal Progress: PROGRESS, PROGRESSIntroduced and defined grade level vocabulary with synonyms with slpmodel/cue and context 4/8. Identified main idea vs. details when given apicture. 2/6. Identified topic starters for september with slp visual/verbal cue.

09/14/201103

10:30 AM -11:00 AM

92508 TM 1. Use and role play class idiom with peers with slp model/cue.2. Intoduce, define, draw pictures for grade level vocabulary (roamed, completed,natural, wildlife) with slp model/cue. Answer wh-questions about main idea andidentify story details with slp scaffolding and modeling.

Goal Progress: PROGRESS, PROGRESSIntroduced defined, and formulated sentences for class vocabualry 2/5.Identified main idea and details for category of the week (solarsystem/space). Identified conversation starters for september/fall with slpmodel/cue. Required cues to stay on topic.

09/16/201103

10:00 AM -10:30 AM

92508 TM 1. Use grade level idiom in conversation with slp cue/model as needed. Identify 3things you can say in september to a peer with slp visual/verbal cue.2. Initiate and answer wh-questions while participating in conversation with peers (2turns) with slp cue.

Goal Progress: PROGRESS, PROGRESSIdentified conversation starters for september with slp model/cue. Initiatedand responded to conversation with slp cue. Defined and used grade levelvocabulary with slp model/cue 8/8.

09/21/201103

10:30 AM -11:00 AM

92508 TM 1. Use and role play class idiom with peers with slp model/cue.2. Intoduce, define, draw pictures for grade level vocabulary (roamed, completed,natural, wildlife) with slp model/cue. Answer wh-questions about main idea andidentify story details with slp scaffolding and modeling.

Goal Progress: PROGRESS, PROGRESSIdentified converstion starter with slp cue. Needed cues for exchange.Introduced, defined, and gave examples for class ideiom, category, word,and vocabulary with slp model/cue. no data. Introduced inferencing with slpmodel/cue.

09/23/201103

10:00 AM -10:30 AM

92508 TM 1. Define and use grade level idiom, word of the week, and category with slpvisual/verbal cue as needed. Answer questions and compare things said to teachervs. peer in fall with slp visual/verbal cue.2. Answer comprehension questions (inference) related to grade levelvocabulary/text with slp visual/verbal cue.

Goal Progress: PROGRESS, PROGRESSDefined and used grade level vocabulary with slp cue 3/6. Answeredquestions about grade level text using inferencing skills with slp cues 1/2.

09/28/201103

10:30 AM -11:00 AM

92508 TM 1. Use and role play class idiom with peers with slp model/cue.2. Intoduce, define, draw pictures for grade level vocabulary (roamed, completed,natural, wildlife) with slp model/cue. Answer wh-questions about main idea andidentify story details with slp scaffolding and modeling.

Goal Progress: PROGRESS, PROGRESSIntroduced grade level vocabulary, idioms, category, word of the week withcontext clues, synonyms, and antonyms with slp model/cue. 4/6. Answeredinference questions with slp model/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 1 of 2

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/30/201103

10:00 AM -10:30 AM

92508 TM 1. Define and use grade level idiom, word of the week, and category with slpvisual/verbal cue as needed. Answer questions and compare things said to teachervs. peer in fall with slp visual/verbal cue.2. Answer comprehension questions (inference) related to grade levelvocabulary/text with slp visual/verbal cue.

Goal Progress: PROGRESS, PROGRESSDefined grade level vocabulary, idiom, word of the week 6/7 without slp cue.Answered comprehension question (inference) with slp cues 8/10. Playedgame using irregular verbs with slp cue. Needed slp cues to stay on topic.

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

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31532Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/02/201103

11:00 AM -11:30 AM

92508 TM 1. Introduce present and past tense verbs (ed). Play verb (ed) bingo, formulate orally,and write regular past tense (ed) verbs from vocabulary with slp model/cue(chuckled/fumbled).2. Define synonyms and identify from word wall with slp visual cue.

Goal Progress: PROGRESS, PROGRESSDefined synonyms and identified from the wall with slp visual/verbal cue15/15. Identified items from the category of the week with slp visual cue(occupations). Introduced present and past tense verbs (ed) with slp cue.Played bingo and formulated sentences with present and past tense verbs(ed) with slp cue 50%.

09/06/201103

03:00 PM -03:30 PM

92508 TM 1. Introduce, define, label, and draw pictures for grade level vocabulary (crackle,announced, soared, starry, envelope, photograph) with slp model/cue. Reviewregular past tense verbs with slp cue.2. Review, write (on whiteboard), and formulate sentences with regular past tenseverbs (while playing Granny's Candies) with slp cue.

Goal Progress: PROGRESS, PROGRESSIntroduced grade level vocabulary and identified synonyms. Answered wh-questions about vocabulary with slp cue. Identified which vocabulary had(ed) past tnese forms with slp cue. no data.

09/13/201103

11:00 AM -11:30 AM

92508 TM 1. Introduce, define, label, and draw pictures for grade level vocabulary(neighborhood, content, addressing, resort) with slp model/cue. Scaffold/modelidentifitying det2. Review, write (on whiteboard), and formulate sentences with regular past tenseverbs (while playing verb bingo) with slp cue.

Goal Progress: PROGRESS, NO PROGRESSIntroduced, defined, and drew pictures for grade level vocabulary, category(space) with slp model/cue. Identified main idea/details from pictures withslp model/cue 8/10.

09/23/201103

11:00 AM -11:30 AM

92508 TM 1. Introduce, define, label, and draw pictures for grade level vocabulary(neighborhood, content, addressing, resort) with slp model/cue. Scaffold/modelidentifitying det2. Review, write (on whiteboard), and formulate sentences with regular past tenseverbs (while playing verb bingo) with slp cue.

Goal Progress: NO PROGRESS, NO PROGRESSReviewed goals and expectations due to behavior.

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

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31532, 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/01/201103

01:50 PM -02:05 PM

92508 TM 1. Play game while defining grade level vocabulary with slp model/cue.2. Play game while defining grade level vocabulary with slp model/cue.

Goal Progress: PROGRESS, PROGRESS[Goal 1: 83]Reviewed grade level vocabulary and defined 5/6. Identified synonyms 6/6,antonyms 3/6 with slp cue. Followed directions with grade level vocabulary(different) 5/7, Reviewed pronouns (he, she, they)

09/07/201103

01:50 PM -02:20 PM

92508 TM 1. Introduce, define, describe, and follow directions with grade level vocabulary withslp model/cue (delighted, thinning, company, wonderful, share, enjoyed). Introduce,model, and answer wh-questions using "main idea book/cards" with slp model/cue.2. Take baseline data.

Goal Progress: PROGRESS, PROGRESSIntroduced grade level vocabulary 1/7 with synonyms and context and slpcue. Drew pictures and wrote sentence using vocabulary with slp model.

09/08/201103

01:50 PM -02:20 PM

92508 TM 1. Review class vocabulary/main idea while playing "Granny's Candies" with slpmodel/cue.2. Review irregular past tense verbs while playing "Granny's Candies" with slpmodel/cue.3. Produce sentence, monitor intelligibility in conversation with slp cue as needed.

Goal Progress: PROGRESS, PROGRESS, PROGRESS[Goal 1: 60]Defined and formulated sentences with class vocabulary. Had to imitateappropriate verb tense when playing "Grannies Candies" for past tenseverbs.

09/12/201103

01:50 PM -02:20 PM

92508 TM 1. Reviewed grade level vocabulary follow directions with grade level vocabularywith slp model/cue (delighted, enjoyed, thinning,). Introduce, model, and answer wh-questions using "main idea book/cards" with slp model/cue.2. Introduce regular past tenese verbs with slp model/cue. Play regular past tensebingo (ed) with slp cue as needed and formulate sentences.3. Produce sentence, monitor intelligibility in conversation with slp cue as needed.

Goal Progress: PROGRESS, PROGRESS, PROGRESSHad difficulty producing grade level vocabulary (wonderful). Required slpmodel. Identified main idea with slp cue 3/5. Identified details 5/10. Definedgrade level vocabulary 6/10 with slp cue.

09/15/201103

01:50 PM -02:20 PM

92508 TM 1. Review class vocabulary/main idea while playing "Granny's Candies" with slpmodel/cue.2. target "who" questions while playing wh-bingo with slp cue.

Goal Progress: PROGRESS, PROGRESSIdentified main idea and details when looking at pictures with slp model/cue9/10 with slp cue. Answered "who" questions without slp cue 10/10 whileplaying game. Reviewed category of the week (space) with slp cue.

09/16/201103

01:50 PM -02:05 PM

92508 TM 1. Play "Grannies Candies" how items are different with slp model/cue to make upfor Labor Day off.2. Identify main idea/details when looking at pictures with slp model/cue.

Goal Progress: PROGRESS, PROGRESSIdentified how items are similiar/different with slp model/cue 4/6. Reviewedvocabulary 6/6 with minimal slp cue. reviewed verbs.

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 3

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Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31532, 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/19/201103

01:50 PM -02:20 PM

92508 TM 1. Reviewed grade level vocabulary follow directions with grade level vocabularywith slp model/cue (flames, forest, heat, safe, tell,). Introduce, model, and answerwh-questions using "main idea book/cards" with slp model/cue.2. Introduce regular past tenese verbs with slp model/cue. Play regular past tensebingo (ed) with slp cue as needed and formulate sentences.3. Produce sentence, monitor intelligibility in conversation with slp cue as needed.

Goal Progress: PROGRESS, NO PROGRESS, NO PROGRESS[Goal 1: 20]Introduced grade level vocabulary, drew pictures and formulated sentenceswith slp model/cue.

09/21/201103

01:50 PM -02:20 PM

92508 TM 1. Reviewed grade level vocabulary follow directions with grade level vocabularywith slp model/cue (flames, forest, heat, safe, tell,). Introduce, model, and answerwh-questions grade level cards/texts with book/cards" with slp model/cue.2. Introduce regular past tenese verbs with slp model/cue. Play regular past tensebingo (ed) with slp cue as needed and formulate sentences.3. Produce sentence, monitor intelligibility in conversation with slp cue as needed.

Goal Progress: PROGRESS, PROGRESS, PROGRESS[Goal 1: 50]Defined and used grade level vocabulary with slp visual/verbal cue. Drewpictures with vocabulary with slp cue. Identified main idea when looking atpictures with slp model/cue. Required slp cue to identify details of pictures.Compared wh-questions and the responses required to complete questionwith slp cue.

09/22/201103

01:50 PM -02:20 PM

92508 TM 1. Review class vocabulary/main idea while playing "Granny's Candies" with slpmodel/cue.

Goal Progress: PROGRESS[Goal 1: 100]Reviewed class vocabulary with slp cue as needed.

09/28/201103

01:50 PM -02:20 PM

92508 TM 1. Reviewed grade level vocabulary follow directions with grade level vocabularywith slp model/cue (flames, forest, heat, safe, tell,). Introduce, model, and answerwh-questions grade level cards/texts with book/cards" with slp model/cue.2. Introduce regular past tenese verbs with slp model/cue. Play regular past tensebingo (ed) with slp cue as needed and formulate sentences.3. Produce sentence, monitor intelligibility in conversation with slp cue as needed.

Goal Progress: PROGRESS, PROGRESS, PROGRESSIntroduced grade level vocabulary with slp model/cue (cultures, signing,deaf, language)1/5. Reviewed main idea/ details with slp visual/verbal 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 3

Page 45: Initials Key: Signaturetherapylog.typepad.com/direct_service_provider/Documents/SAMPLE... · /sk/ blends in words while playing bingo. 150x with minimal slp cueing ... Review word,

Month-End Billing Documentation for September 2011 Some School District

Student (DOB): Student, Test (01/25/1969) Diagnosis Code(s): 31532, 31539Service Date

SettingTime Service Activity(ies) Progress/Comments Initials

09/29/201103

01:50 PM -02:20 PM

92508 TM 1. Review class vocabulary/main idea while playing "Granny's Candies" with slpmodel/cue.2. Review irregular past tense verbs while playing "Granny's Candies" with slpmodel/cue.3. Produce sentence, monitor intelligibility in conversation with slp cue as needed.

Goal Progress: PROGRESS, PROGRESS, PROGRESSDefined grade level vocabulary and formulated pictures. 3/7 Answeredquestions while playing games with irregular verbs with slp cues incomplete sentences 5/10. Reviewed main idea/details with slp model/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 3 of 3

Page 46: Initials Key: Signaturetherapylog.typepad.com/direct_service_provider/Documents/SAMPLE... · /sk/ blends in words while playing bingo. 150x with minimal slp cueing ... Review word,