Re-Entry Progress Note

Re-Entry Progress Note
Name*

First NameLast Name
DUI Program Location*
Next Section For Counselor Use
Date

___________________________________________
Topic

___________________________________________________________________

___________________________________________________________________
Time In

___________________________________________
Time Out

___________________________________________
Goals
1. Employment*

EmployedUnemployedInterviewingMailing ResumesNewspaper
Progress and Participations ______________________________________________

____________________________________________________________________________
2. Family Relationship*

No ImprovementSameImprovingIncreased CommunicationIdentifying Problems
Progress and Participations ______________________________________________

____________________________________________________________________________
3. Community Resources*

EDD OfficeChurchCounty ProgramsWork/EducationOther
Progress and Participations ______________________________________________

____________________________________________________________________________
4. Self-Help Groups*

Not AttendingAttending AACACODAOtherWeeklyBi-Weekly
Progress and Participations ______________________________________________

____________________________________________________________________________
5. Personal Goals*

No ImprovementImproving In BehaviorAttitudeSober Lifestyle
Progress and Participations ______________________________________________

____________________________________________________________________________
6. Relapse Prevention*

Identifying RisksLifestyle ChangesRecognizing Symptoms
Progress and Participations ______________________________________________

____________________________________________________________________________
Signature

Clear
Date*

MonthDayYear
Date
Counselor observation of client participation in group (circle one):

Attentive Involved Defensive Withdrawn

Counselor Signature _____________________________________

Date ______________________________________
Should be Empty:

Re-Entry Progress Note

Goals