TREATMENT ATTENDANCE LETTER

[Program or practice name]
[Address]
[Phone and email]

Date: [Date you write the letter]
To: [Name and role of the recipient named in the consent, such as the probation officer]
Their reference: [Court file or supervision number, if the consent allows it; otherwise delete this line]

Re: [Patient's full name]
Date of birth: [Date]

CONSENT
Signed in writing on: [Date]
It allows us to tell: [Each recipient the consent names]
It covers: [Attendance only, or attendance with participation, progress, test results, and the plan]
It ends: [Date or event], and it can be revoked: [The terms the consent sets out]
Attached: [A copy of the consent, or a summary of what it covers]

PROGRAM
Treatment: [Program name and type, such as outpatient substance use treatment, counseling, or anger management]
Required or recommended by: [Court, probation, parole, or lawyer, and the treatment condition as written, if we have it]
Started on: [Date of admission or first session]
Schedule: [How many sessions a week, and of which kind]
Current status: [Active, completed on a date, or discharged on a date]
Diagnosis: [Not included, or only what the consent covers and the order needs]

ATTENDANCE
Reporting period: [First date] to [last date], from our attendance records
Sessions scheduled: [Number]
Attended: [Number]
Missed: [Number, with each date]
Excused under our policy: [Number, with each date and the reason in general terms]

PARTICIPATION AND PROGRESS
[If the consent covers it: what the patient has completed and which treatment goals are met or still open, from the record. If not: Not included; the consent covers attendance only.]

TEST RESULTS
[If the consent covers them and the program tests: each date, what was tested, the result, and whether a lab confirmed it. Otherwise delete this section.]

PLAN
Next steps: [What happens next, such as the same schedule or a step down]
Expected end date: [Date, or the date of the next review]
Next update: [Date, if the recipient asked for regular reports]

This letter reports what our records show. It does not describe what the patient said in sessions and gives no opinion on the risk of reoffending. Whether this attendance meets the order is for the court or the supervising officer to decide.

[Any confidentiality notice the law requires with this disclosure; otherwise delete this line]

[Your name, credentials, and role in the program]
[License or registration number]
[Signature]