Progress Review Meeting Summary Form

Person Name *

Program Name *

Date of team meeting *

This program must participate in service planning and support team meetings for the person following the stated timelines established in the person’s coordinated service and support plan or as requested by the person or the person’s legal representative, the support team, or the expanded support team. [245D.07, subdivision 2 and 245D.071, subdivision 5]. For a person receiving intensive support services, meetings must also occur within 30 days of a written request by the person, their legal representative, or the case manager at a minimum of once per year.

Did the resident participate in the meeting and the discussion of goals?

Yes

No

Is the CSSP provided and current (date of CSSP available)?

Yes

No

If the CSSP is not current, was this requested of the case manager at this meeting?

Yes

No

Does the CSSP reflect required meeting and reporting frequencies:

Meeting Frequency

Annually

Semi-annually

Quarterly

Reporting Frequency

Annually

Semi-annually

Quarterly

1. How has this program provided services in response to your identified needs, interests, preferences, and desired outcomes as specified in the coordinated service and support plan and the coordinated service and support plan addendum?

2. How has this program provided services to you in a manner that supports your preferences, daily needs, and activities and accomplishment of your personal goals and service outcomes?

3. How has this program provided services to you consistent with the principles of person-centered service planning and delivery that:

A. Identifies and supports what is important to you as well as what is important for you, including your preferences for when, how, and by whom direct support service is provided to you?

B. Uses that information to identify outcomes you desire?

C. Respects your history, dignity, and cultural background?

Other Discussion/Responsibility:

The Progress Review/CSSP/CSSP Addendum Report was discussed at the meeting. The following changes were made or requested (for CSSP update)

The following outcomes in addition to those identified in the Progress Review Report will be implemented

4. Support/Interdisciplinary Team Members

Name

Signature

Title

Name

Signature

Title

Name

Signature

Title

Name

Signature

Title

Name

Signature

Title

Name

Signature

Title

Name

Signature

Title