Appointment Notes and Risk Assessment Counselling Appointment NotesTo be completed no later 7 days after the counselling appointment.Name of Client *Name of Counsellor *Date of appointment *Day *Month *Year *Time of appointment *Hours-000102030405060708091011121314151617181920212223Minutes-000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859Session Number *Was the appointment attended? *YESNODNA/CANCELEDWhat was the intended method of contact, phone, skype, google meet, etc? *Appointment Notes: Include here, what was discussed, explored, reviewed and planned with the client as part of your session.Risk AssessmentTo be completed at every appointment.IF THERE IS ANY RISK PLEASE DETAIL BELOW (CHECK FOR RISK AT EVERY APPOINTMENT) IF THE RISK IS MEDIUM ALSO COMPLETE A SAFE PLAN WITH THE CLIENT SEPERATE TO THIS DOCUMENTSUICIDAL IDEATIONSELF HARMURGENT MEDICAL ATTENTIONNONE OF THE ABOVE - N/A - UNABLE TO ASSESSNOW ASSESS THE LEVEL OF RISKSELECTZERO RISK - NO THOUGHTS PLAN OR INTENT - SKIP RISK ASSESSMENTLOW RISK - THOUGHTS PRESENT, NO PLAN NO INTENT - GIVE VERBAL ADVICE TO CONTACT 111 OR 999 IF THOUGHTS PERSIST OR A PLAN DEVELOPSMEDIUM RISK - THOUGHTS ARE PRESENT WITH A CLEAR PLAN, NO INTENT - COMPLETE 111 ONLINE NHS ASSESSMENTHIGH RISK - THOUGHTS , PLAN & INTENT ARE PRESENT - CALL 999 & INFORM YOUR TLDNA / NOT APPLICABLEDETAILS OF THOUGHTS, PLAN OR INTENT OF SUICIDE/SELF HARM OR URGENT MEDICAL ATTENTIONCOPY AND PASTE THE ADVICE WHICH WAS GIVEN FROM THE NHS 111 ONLINE ASSESSMENT HERE:GIVE CLIENT ADVICE FROM ASSESSMENT ABOVE: IS THE CLIENT ACTING ON THE ADVICE?SELECTYESNO - SEE NEXT QUESTIONBased on the above, do you consider that the client is in danger, or a further risk to themselves or others?SELECTYES - DETAIL ANY ACTION YOU HAVE TAKEN BELOWNO - END OF ASSESSMENT CARRY ON WITH THE CALL & RECORD FORMDETAILS OF ANY ACTION I TOOK MYSELF: EXAMPLE: FROM THE 111 ASSESSMENTIs there a Complaint, Safeguarding or Incident issue from this appointment? *SELECTNOYES - COMPLETE CSI REPORT FORM - INFORM SAFEGUARDING LEADCSI REFERENCE NUMBEROutcome of appointment *Next session booked as plannedDischarged DNA/CANDischarged Work CompleteDischarged Other – please note below – or write N?A if neededNot Applicable [other] detail belowDNADate of next appointmentTime of next appointmentHours-000102030405060708091011121314151617181920212223Minutes-000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859Other discharge reason / other outcome if required if not required enter N/ADate Of Submitting Notes *Day *Month *Year *Time of submitting Notes *Hours-000102030405060708091011121314151617181920212223Minutes-000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859SUBMIT FORM
