General Behavioral Health Integration Time Log

Monthly time log for clinical staff to document time spent supporting general behavioral health integration billing and related care coordination activities.

Log Details

• Reporting Month
  Select any date within the month being reported. The log should cover one calendar month only.
• Staff Name
  Enter the name of the clinical staff member completing this log.
• Role / Title
  Enter the staff member's role relevant to behavioral health integration activities.
• Department / Clinic
  Optional: identify the clinic or department for internal review and routing.

Time Entry Summary

• Total Minutes Spent on Behavioral Health Integration Activities
  Enter the total number of minutes spent on qualifying behavioral health integration activities for the reporting month.
• Activity Types Performed
  Select all activity types that apply. Use progressive disclosure in supporting documentation if more detail is needed.
• Time Tracking Method
  Select how the time was captured for this log.
• I confirm the recorded time reflects qualifying behavioral health integration activities only.
  Confirm that the time entered excludes non-qualifying tasks and follows your organization’s billing policy.

Supporting Details

• Number of Patients Supported
  Optional: enter the number of patients supported during the month if your organization requires this for internal review.
• Summary Notes
  Briefly describe the nature of the work performed. Do not include unnecessary PII or full patient identifiers.
• Supporting Documentation
  Upload any supporting records required by your organization for audit trail or billing review.

Review and Attestation

• Attestation
  I attest that this time log is accurate, complete, and prepared in accordance with organizational policy and applicable billing requirements.
• Supervisor / Reviewer Name
  Optional: enter the reviewer name if your workflow requires supervisory approval.
• Review Date
  Optional: date the log was reviewed or approved.