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com Sample Discharge Summary Report
Client Name: Minnie Mouse Date of Report: 11/4/2014
Client Information: This section could include DOB, client diagnosis, client medications, start and stop
dates of services, frequency of services, ID/Medicaid number or SSN, etc.
Name and Title of person completing report: Daffy Duck, Program Manager, BCBA
Reason for Admission:
Minnie displayed severe food refusal, encopresis, aggression, defiant behaviors, threat making
behaviors, property destruction, obsessive/repetitive behaviors, and task refusal behaviors in addition
to having social interaction deficits.
Reason for Discharge:
Services were temporarily privately funded pending reinstatement of a therapy grant. The grant was
recently (within 21 days) denied, and the family has declined to continue with private pay. For this
reason, ABA services have been terminated.
Progress Made on Goals and Objectives:
Progress towards goals has been inconsistent for multiple reasons: several modifications were made to
the Toileting and Feeding protocols at the request of the parent or the ABA staff. These multiple
changes caused progress to stall, or to be variable. This also caused a delay in proper implementation of
these programs. In addition, due to the Christmas holiday and a recent out of state trip with family, the
therapy schedule has been modified multiple times over the past 6 weeks. In addition, parental
adherence to treatment goals and protocols has been quite low. Minnie has made limited progress with
learning replacement behaviors for repetitive/obsessive behaviors, independently completing daily
living tasks, and following a visual schedule when transitioning from a preferred to a non-preferred task
is required.
Individual’s Current Level of Functioning/Functioning Limitations:
Minnie is currently able to vocally request things she wants and needs, although when frustrated or
agitated Minnie may engage in tantrum, aggression, and screaming behaviors instead of using language.
Minnie has difficulty waiting for reinforcement, interacting appropriately with peers, and de-escalating
once she becomes agitated. Minnie functions best when schedules and transition cues are consistently
used, and when she is offered multiple choices throughout her day.
Individual’s Participation in Discharge Summary:
Minnie did not participate in this discharge. The Discharge was reviewed with the biological parents
both verbally and in writing, over the past 2 months.
www.Iloveaba.com Sample Discharge Summary Report
Recommendations on Reinstating Services:
Should a funding source become available, the family is welcome to reapply for services and would need
to briefly go on a waiting list until direct staff and a Program Manager become available. In addition,
parental adherence to treatment goals must see a significant improvement.
Other Potential Service Providers:
List local providers here that offer equivalent services to what the client was previously receiving. Full
contact information should also be included.
