What is Progress notes?

Also known as: Case notes, shift notes

Progress notes are the written record of what happened during a support: what was delivered, how the participant responded, and anything of concern. They are the primary evidence that a claimed support was actually provided, and they are what an auditor, a plan reviewer or a coroner reads when a decision is questioned.

A note serves three audiences at once: the next worker on shift, the plan reviewer deciding future funding, and any subsequent investigation. Notes written only for the first are the reason plans get reduced and claims get queried.

Good practice is factual and specific — what was observed, what was done, what changed — separated clearly from opinion. Notes should be written at or near the time of the support, because a note written days later has materially less evidentiary weight.

Under the Practice Standards, records must be accurate, contemporaneous and retained. Retrospective editing should be visible rather than silent.

Related terms

NDIS Practice StandardsThe NDIS Practice Standards set the quality requirements registered providers must meet, covering rights and responsibilities, governance and operational management, the delivery of supports, and the provider’s environment. Registered providers are audited against the standards relevant to the registration groups they hold.Reportable incidentA reportable incident is an event a registered NDIS provider must report to the NDIS Quality and Safeguards Commission. The categories are death, serious injury, abuse or neglect, unlawful sexual or physical contact, sexual misconduct, and the unauthorised use of a restrictive practice. Initial reports are due within 24 hours or five business days depending on category.Reasonable and necessary“Reasonable and necessary” is the statutory test the NDIA applies when deciding whether to fund a support. The support must relate to the participant’s disability, represent value for money, be likely to be effective and beneficial, take account of informal supports, and not be the responsibility of another service system such as health or education.EVVElectronic Visit Verification is the electronic capture of when and where a support actually started and finished, typically by a worker clocking in and out on a phone with GPS. It provides evidence that a claimed support was delivered at the stated time and place, replacing self-reported timesheets.

More in Compliance

Restrictive practice NDIS Commission NDIS Worker Screening Check

Rostery handles this in practice

SCHADS interpretation, NDIS price-guide validation, claiming and the evidence an audit asks for — built for Australian providers.

Book a demo See the features