Case Closure Form

Document the formal close-out of an investigation or case file, capturing the reasons, outcomes, and sign-off from those responsible.

Use this template

Case Manager Name

First Name

Last Name

Case Record Number

Case Starting Date

Case Ending Date

Reason(s) for Closure

Services Provided and Progress Toward Goals

Does the client know about the case closure? (if applicable)

Yes No

How was the client notified?

Transfer, discharge, follow-up, or other plans

Case Manager Signature

Sign here

Date

Supervisor Signature

Sign here

Date

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