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Run: Service Plan Quarterly Review and Update Form

A 90-day service plan review form for documenting goal progress, barriers, risk changes, and updated interventions. Use it to keep case notes current, suppor...

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Review Period and Administrative Details

Client ID / Case Number (required)

Enter the unique client or case identifier from your case management system. Do not enter the client's full name here.

Client Initials (required)

Use initials only to minimize PII exposure in this record header.

Program / Service Line (required)

If 'Other', specify program name

Review Quarter (required)

Select the quarter relative to the client's program enrollment date.

Date of This Review (required)

The date the review meeting or assessment was conducted.

Original Service Plan Date (required)

Date the initial or most recently approved service plan was signed.

Next Scheduled Review Date (required)

Typically 90 days from today's review date.

Case Manager Name (required)

Credentials / Title

Supervising Case Manager / Program Supervisor (required)

Did the client participate in this review? (required)

Participation Notes

Required if client did not fully participate.

Goal Progress Review

Goal 1 — Description (required)

Goal 1 — Current Status (required)

Goal 1 — Progress Rating (required)

Goal 1 — Progress Narrative (required)

Is there a Goal 2?

Yes No N/A

Goal 2 — Description

Goal 2 — Current Status

Goal 2 — Progress Rating

Goal 2 — Progress Narrative

Is there a Goal 3?

Yes No N/A

Goal 3 — Description

Goal 3 — Current Status

Goal 3 — Progress Rating

Goal 3 — Progress Narrative

Goals 4–5 — Additional Goal Progress (if applicable)

Optional. Use if the service plan contains more than three active goals.

Barriers and Challenges

Were significant barriers to goal progress identified this quarter? (required)

Barrier Categories (select all that apply)

Select all barrier types that applied during this review period.

Barrier Narrative

Be specific: 'Client lost Medicaid coverage on 01/15 due to renewal gap; reapplication submitted 01/22, pending' is more actionable than 'benefits issue'.

Actions Taken or Planned to Address Barriers

Were external referrals made this quarter? (required)

Referral Details

Updated Goals and Revised Interventions

Are changes to the service plan required following this review? (required)

Revised or New Goals for Next Quarter

Example: 'Revised Goal 1: Client will complete 10 job applications per week and attend at least 2 interviews by 06/30.'

Revised or New Interventions / Action Steps

Goals Closed or Discontinued This Quarter

Services or Supports Added to Plan

Services or Supports Discontinued

Risk Reassessment and Safety

Current Overall Risk Level (required)

Assign based on your agency's standardized risk assessment tool (e.g., Columbia Protocol, DAST-10, VI-SPDAT, or equivalent).

Risk Level Change Since Last Review (required)

Are any of the following safety concerns currently present? (select all that apply)

Is a current safety plan in place?

Risk and Safety Narrative

Required if risk level is Moderate, High, or Critical.

Was a mandatory report filed this quarter? (required)

Mandatory reporting obligations vary by state and role. Consult your supervisor if uncertain.

Overall Review Summary and Disposition

Overall Client Progress This Quarter (required)

Client Engagement Level This Quarter (required)

Quarterly Summary Narrative (required)

Write in clear, professional, person-first language. Avoid jargon and subjective characterizations.

Recommended Disposition (required)

Transition / Discharge Planning Notes

Is supervisor consultation required before next contact? (required)

Reason for Supervisor Consultation

Supporting Documents (optional)

Attach updated service plan, assessment tools, referral confirmations, or other relevant documents. Do not attach documents containing full SSN, financial account numbers, or other sensitive PII beyond what is required by your agency's document retention policy.

Attestations and Signatures

Case Manager Attestation (required)

I attest that the information documented in this quarterly review is accurate and complete to the best of my knowledge, reflects direct observation and client-reported information, and was completed in accordance with my agency's case management standards and applicable regulations.

Yes No N/A

Case Manager Signature (required)

Case Manager Signature Date (required)

Supervisor Review Notes

Supervisor Attestation (required)

I have reviewed this quarterly service plan update, confirm it meets agency documentation standards, and approve the recommended disposition and plan revisions as documented.

Yes No N/A

Supervisor Signature (required)

Supervisor Signature Date (required)

Was a copy of this review provided or offered to the client? (required)

Clients have the right to receive a copy of their service plan review per most program regulations and best practice standards.

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