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Individual/Couple/Family Session?
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Group session?
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Type of session? (Select one)
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More than one facilitator? (Click if yes)
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Who Co-Facilitated? (Select from dropdown)
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Other co-facilitator not listed in drop-down? (example: "Eugene Porter, PhD")
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Person other than patient present? (Click if yes)
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Who else was present? (example: "Rick Grimes, his father, and Lori Grimes, his mother,")
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Was only one other person present? (Click if yes)
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Was more than one other person present? (Click if yes)
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Group guidelines (example: "Patients were verbally oriented to group guidelines, including respect for others, limitations of confidentiality, and safety practices.")
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OLD Describe individual/couple/family session interventions.
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OLD Describe any animal-assisted or experiential services provided.
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OLD Describe patient response to interventions.
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OLD Describe group session interventions.
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OLD Describe any animal-assisted or experiential services provided.
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OLD Describe patient response to interventions.
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Free Text (Instead of using some or all of the above fields, you can write your own intervention section or add information with free text here.)
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Old Field, leave blank
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Old Field, leave blank
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