**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:** 20/10/2026
**Summary of input provided (eg number of sessions, modality of treatment, type of intervention, frequency)**
The kiritaki has attended a further eight sessions of weekly individual psychological treatment since the last report, continuing the cognitive behavioural therapy approach with a focus on trauma-related anxiety, graded exposure to workplace triggers, and relapse-prevention planning as treatment nears completion.
**Functional goals**
| Goal | Progress | Status |
| --- | --- | --- |
| Reduce hypervigilance and startle response so the kiritaki can attend the workplace without significant distress (target 4 days/week). | The kiritaki reported reaching and sustaining 4 days per week of workplace attendance over the past four weeks, with minimal residual startle response. | Achieved. |
| Improve sleep continuity (target waking no more than once per night). | The kiritaki reported consistently waking no more than once per night for the past six weeks. | Achieved. |
**Outline any barriers which are impacting progress:**
None reported at this stage.
**Reason for more sessions if needed:**
The kiritaki has achieved both functional goals set in the previous report. A small number of further sessions are recommended to consolidate gains and support relapse prevention before treatment concludes.
**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):
**New functional goals to be achieved**
| Goal | Intervention | Measurement |
| --- | --- | --- |
| Maintain workplace attendance and sleep gains independently, without ongoing weekly sessions. | Relapse-prevention planning, including a written plan of coping strategies and early-warning signs. | Self-report at a final review session in 8 weeks; repeat DASS-21 Anxiety subscale. |
Any other comments or input required for the kiritaki:
The kiritaki's presentation has responded well to treatment; no further mental injury assessment is considered necessary. A treatment review is proposed to confirm readiness for discharge.
**6. Provider declaration**
Provide the date of the last appointment with the kiritaki that informed this report: 15/12/2026
☒ 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: 15/12/2026
**Psychologist name:** Dr Sigmund Freud Date: 15/12/2026