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Allied Health Professional-Vorlage

ACC267 Psychological services progress report [Updated]

Eine professionelle Allied Health Professional-Vorlage für medizinisches Fachpersonal.
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Allied Health Professional

Genutzt

7 Zeiten

Art

Note

Zuletzt bearbeitet

31.7.2026

Erstellt von

Dr Sarah Manig

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Streamline your psychological services progress reporting with this comprehensive ACC267 template, designed for New Zealand ACC-registered psychologists submitting interim progress reports for an ACC claimant. It captures provider, claimant, and case manager details, the functional objectives achieved with comments, the specific outcome from remaining sessions, and the functional objectives still to be reached with target dates and measurement criteria. Easily document reasons for amendments to intended services, request further sessions with rationale and timeframes, and record progress towards independence and case manager approval. This template ensures every section of ACC's progress reporting is captured systematically. Ideal for psychologists submitting structured mid-programme progress reports for an individual claimant.

Vorlagenvorschau

**Part A: Kiritaki information** **1. Kiritaki details** Kiritaki name: John Smith Date of birth: 03/03/1979 Claim number: ACC000-TESTCLAIM-01 Address: 1 Example Street, Christchurch **Update on treatment and behavioural outcome measures** **Date of Action Plan and/or last Progress Report:** 15/09/2026 **Summary of input provided (eg number of sessions, modality of treatment, type of intervention, frequency)** The kiritaki has attended six sessions of weekly individual psychological treatment since the last report, using a cognitive behavioural therapy approach with a focus on trauma-related anxiety. Sessions have included psychoeducation on the anxiety response, graded exposure to workplace-related triggers, and breathing and relaxation exercises practised between sessions. **Functional goals** | Goal | Progress | Status | | --- | --- | --- | | Reduce hypervigilance and startle response so the kiritaki can attend the workplace without significant distress (from 1 day/week to 4 days/week). | The kiritaki reported a steady increase in workplace attendance, now managing 3 days per week, with graded exposure exercises supporting this. He reported reduced startle response to loud noises. | Partially achieved – on track, target of 4 days per week not yet reached. | | Improve sleep continuity (from waking 3–4 times per night to no more than once per night). | The kiritaki reported using the sleep hygiene strategies discussed and now wakes on average once per night, down from 3–4 times. | Achieved. | **Outline any barriers which are impacting progress:** The kiritaki reported that ongoing demands of managing his business independently have limited the time available for practising strategies between sessions. **Reason for more sessions if needed:** The kiritaki has engaged well and made measurable progress on both functional goals, but has not yet reached his workplace-attendance target. Continued weekly sessions are recommended to consolidate gains and support a full return to his previous work pattern. **Mental injury assessment (Max. 16 Hours)** Please indicate the proposed next stage: ☐ Treatment with approved mental injury cover (Max. 24 Hours): ☒ Treatment without approved mental injury cover (Max. 10 Hours): ☐ Treatment review (Max. 11 Hours): If additional sessions are required for treatment without ACC approved mental injury cover, identify why a mental injury assessment is not indicated at this stage: The kiritaki's presentation remains consistent with the difficulties identified at initial assessment and continues to respond to the current treatment approach, so a further mental injury assessment is not considered necessary at this stage. **6. Provider declaration** Provide the date of the last appointment with the kiritaki that informed this report: 20/10/2026 ☒ I have informed the kiritaki that the information collected for this report will be sent to ACC to support cover decisions and treatment and rehabilitation needs. The kiritaki understands this. ☒ I confirm that the information contained in this report is accurate and aligns with ACC's report standards. Date: 20/10/2026 **Psychologist name:** Dr Selina Kyle Date: 20/10/2026

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