How to write objective, concise and professional Progress Notes. 11 Examples of progress notes, both good and bad versions, included.

Progress Notes are brief narrative entries written to record negative and positive events relating to residents. They are also used to record situations regarded as irregular, and residents’ response to lifestyle issues.

In this article we cover:

  • What should be recorded as a Progress Note?
  • How to record Progress Notes
  • Be Objective and Brief
  • Always read through existing Progress Notes
  • 11 Progress Notes Samples - Good & Bad:

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Pamela 23rd Dec 2018 Certified Occupational Therapy Assistance And Activity Director
Hello, I need an initial activity care plan for a new adult day service. Are there care plan templates?
Pat 15th Feb 2018 Activities
how to write a significant change progress note
Solange 15th Feb 2018 Diversional Therapist
Hi Pat, I don’t know if I understood your question. Progress Notes are a succinct summary of relevant facts occurred to clients on your shift. For instance, if support for a client is increased, due to health deterioration, you should write what support was provided and how the client managed (mood). Stick to essential information you have observed and report what client says oo/and feels. Write events in an objective, respectful, and non-judgmental manner; refrain from using words like: uncooperative, abusive, hysterical, but if you need adverbs have them accompanied by an explanation/clarification of the circumstances. The significance of Progress Notes depends on following the guidelines and your choice of words.
Melissa 14th Feb 2018 HCP Coordinator
Progress notes are an ongoing struggle for all, this is a great little refresher. Thanks!
Talita 17th Feb 2018
Thanks for your feedback Melissa!
Wendy 16th Aug 2017 Residential & Community Care Coordinator
Progress notes are challenging and I believe we all need education on that especially in care plans where they are Patient centred, and getting all staff involved.
Rhonda 13th Aug 2017 Registered Nurse
I would like to know how to write better progress notes as a registered nurse
judy 9th Sep 2009 Gerontologist
fabulous,thanks so much...looking forward very much to the identifying needs, writing goals write up.