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Rooted
in
Hope
Therapy
Confidential Clinical Document
Group Participant Roster
Healing takes root.
Hope grows here.
Group Name / Program
Cohort / Cycle
Day & Time
Start Date
End Date
Facilitator
Attendance Key:
P = Present
A = Absent (Unexcused)
E = Excused Absence
L = Late / Partial
V = Virtual / Telehealth
#
Participant Name
Date of Birth
Phone
Insurance
Status
Wk 1
Wk 2
Wk 3
Wk 4
Wk 5
Wk 6
Wk 7
Wk 8
Wk 9
Wk 10
Wk 11
Wk 12
Total
Notes / Flags
Session Summary
Total Enrolled:
Sessions Held:
Avg. Attendance:
Step-Up / Step-Down
Stepped Up to IOP:
Stepped Down / DC'd:
Completed Cohort:
Group Notes
Facilitating Clinician
Signature
Date Completed
Supervisor Review