245D Progress Note Form Staff Full Name* First Last Client's Full Name* First Last Service Type Provided*IHS - Individualized Home Supports (No Training)ICLS - Community Living SupportIn-Home Respite CareOut-of-Home Respite CareNighttime SupervisionHomemaking (General)Homemaking (With ADL Support)Date of Service Provided* MM slash DD slash YYYY Support Tasks Completed During This Shift* Assistance with Personal Care (e.g., hygiene, dressing) Community Integration (e.g., errands, activities) Skill-Building for Independence (e.g., cooking, laundry) Other (specify in comments) Activity Summary and Support Provided*Additional Notes or Observations
