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Run: General Behavioral Health Integration Time Log

Log monthly behavioral health integration time spent on billing-eligible care coordination, with a clear summary of activities, supporting notes, and supervi...

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Log Details

Reporting Month (required)

Select any date within the month being reported. The log should cover one calendar month only.

Staff Name (required)

Enter the name of the clinical staff member completing this log.

Role / Title (required)

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 (required)

Enter the total number of minutes spent on qualifying behavioral health integration activities for the reporting month.

Activity Types Performed (required)

Select all activity types that apply. Use progressive disclosure in supporting documentation if more detail is needed.

Time Tracking Method (required)

Select how the time was captured for this log.

I confirm the recorded time reflects qualifying behavioral health integration activities only. (required)

Confirm that the time entered excludes non-qualifying tasks and follows your organization’s billing policy.

Yes No N/A

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 (required)

I attest that this time log is accurate, complete, and prepared in accordance with organizational policy and applicable billing requirements.

Yes No N/A

Supervisor / Reviewer Name

Optional: enter the reviewer name if your workflow requires supervisory approval.

Review Date

Optional: date the log was reviewed or approved.

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Email (required)

Your name (optional)

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