Number of Pages: 18

Format: Word Template (.dotx)

Who is it for?

• BCBA

What is it?

• This document contains 2 treatment plan templates. One for Initial Treatment Plan, and another one for Updated Treatment Plan 

• The template includes the following sections that are commonly required by payors in order to obtain authorizations:

  • Member, provider, client identification information

  • Request for treatment hours

  • Description of service: ABA service, related service, and care coordination

  • Report of school schedule

  • Description of case supervision

  • Description of caregiver training

  • Intake Assessment Summary (for initial treatment plan)

  • Summary of progress and summary of challenges (for updated treatment plan)

  • Chief complaints from guardians

  • Medical histories

  • Family background

  • Assessment summary

  • Individualized treatment goals (and report of data/graph)

  • Service hours fading critieria (*sample description is included, but user's edit is advised)

  • Discharge criteria (*sample description is included, but user's edit is advised)

  • Treatment plan consent form

Why should you use it?

• Treatment plan is often required to obtain ABA service authorization from payors.

• A treatment plan also summarizes the cilent's progress during a given period of time