Personal Care Assistant Daily Log 2014 2015
Early Intervention
Sheet:
School Age
of:
Student Information
LEA Name
(School District,
IU, etc.)
Date
Student Name
PA
Secure
ID
Provider Information
PCA:
Signature:
PCA:
Signature:
PCA:
Signature:
Time In
Time
Out
Description of Service (daily notes on activity, location, and outcome)
Service
Type
Treatment
Key
Progress
Indicator
Key
PCA
Initials
R
Service Type:
D = Direct
PNA = Provider Not Available
SA = Student Absent
Supervisor’s
Name:
Public Consulting Group
PA = Provider Absent
DM = Direct Session: Make-up Session
SNA = Student Not Available
Progress Indicator Type
Mn = Maintaining
Rg = Regressing
Ev = Evaluation
Ms = Mastering
Supervisor’s
Signature:
http://www.publicconsultinggroup.com/client/paaccess/
In = Inconsistent
Pr = Progressing
Date:
SBAPsupport@pcgus.com
(866) 912-2976
Updated: 6/27/2014
Personal Care Assistant Daily Log 2014 2015
Treatment Key:
1
2
3
4
5
6
Direct
Direct
Direct
Direct
Direct
Direct
7
Direct
8
9
Direct
Direct
10
Direct
Public Consulting Group
Assisting the student to use equipment
Assisting the student to use and maintain augmentative communication devices
Assisting the student to ambulate, position, and transfer
Range of motion and other exercises
Activities of daily living such as eating, grooming, bathing, toileting, etc.
Monitoring the incidence and prevalence of designated health problems or medical
conditions, e.g., seizure precautions or extreme lethargy
Hands-on assistance, cueing, or supervision of medical/mental health-related services
provided by the PCA under the direct (on-site) supervision of the professional nurse.
Activities may include catheterizations, suctioning, oxygen admin, and tube feedings.
Observing and intervening to redirect inappropriate behavior
Assisting, monitoring, and guiding the student to pay attention, participate in
activities, and complete tasks
Accompanying students on school buses or other vehicles. A PCA’s presence is
necessary because of a student’s physical disability or mental health disability
http://www.publicconsultinggroup.com/client/paaccess/
SBAPsupport@pcgus.com
(866) 912-2976
Updated: 6/27/2014