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A BIRP note is a four-part progress note format that organizes a session into Behavior, Intervention, Response, and Plan. Its signature strength is forcing the intervention-and-response thread onto the page, which is exactly what payer reviewers read for. A typical BIRP note runs 150 to 300 words.
Therapists, counselors, case managers, community and public behavioral health teams
Treating clinician, care team, supervisors, payers, auditors
150 to 300 words · 10 to 20 minutes by hand (clinical team estimate)
Structured progress note (compare: SOAP, DAP; GIRP and SIRP are sibling variants)
After each individual, group, or case-management contact
A documentation convention, not a mandated form; California's Medi-Cal policy is now explicitly format-neutral
BIRP stands for Behavior, Intervention, Response, Plan. It is a four-part progress note format built around a simple thread: what you observed, what you did, how the client responded, and what happens next. Unlike SOAP, no primary source we reviewed identifies a creator or standards body for BIRP; it grew up as a workflow convention inside community and public behavioral health systems, alongside sibling variants like GIRP (Goal first) and SIRP (Situation first). Australian services often spell it out as Behaviour, Intervention, Response, and Plan. Notably, systems that once mandated these formats are moving away from doing so: California's Medi-Cal behavioral health policy is now explicitly format-neutral, and county guidance under CalAIM states the old BIRP/GIRP/SIRP/SOAP format choices are no longer required.
The boundary that actually matters is legal, not structural. A working BIRP note contains progress, plan content, and often session timing, so under HIPAA it is a progress note in the standard clinical record, not a separately protected "psychotherapy note": that narrow category excludes diagnosis, treatment plan, symptoms, prognosis, progress, and counseling start and stop times, and calling a chart note a psychotherapy note does not change its status (see the psychotherapy notes authorization page).
BIRP's home turf is community mental health, public behavioral health systems, substance-use programs, and case management, settings where many hands touch a chart and reviewers need the intervention-and-response loop visible at a glance. It also serves solo clinicians who want their notes to read the way auditors read: Medicare's psychotherapy coverage policy asks for the interventions used, the patient's participation and reaction, and progress toward goal-oriented outcomes, which is BIRP's exact skeleton. Prefer SOAP in medically integrated settings, DAP when a single merged Data section fits a qualitative flow, and GIRP when your program organizes notes around the goal rather than the behavior. No payer or regulator we reviewed requires any of these by name.
Each section in more detail, with the pitfall that most often undermines it:
B: Behavior. Observables first: appearance, affect, engagement, quotes, screening scores (PHQ-9, GAD-7, PCL-5), plus the client's report. Pitfall: opinions written as observations; "manipulative" is a judgment, "asked three times to extend the session" is a behavior.
I: Intervention. Name what you actually did: cognitive restructuring, exposure work, motivational interviewing, skills training, and tie it to the goal it serves. Pitfall: "supportive psychotherapy given"; Medicare's psychotherapy coverage policy says that phrase alone is not adequate documentation.
R: Response. The section reviewers read first: participation, reaction to each intervention, and symptom or behavior change, or the lack of it. Pitfall: skipping response entirely, which turns the note into a record that something happened rather than evidence it did anything.
P: Plan. Specific and dated: next interventions, homework, coordination, next appointment, and the rationale for any change to the treatment plan. Pitfall: a bare "continue treatment" with no thread back to the goal.
Client: [initials] Date: Session #: Service: [type/length] Start/stop or total time: B (Behavior): I (Intervention): R (Response): P (Plan): Clinician signature/credentials: Date signed:
Free to use and share, no signup. The PDF includes a one-page cheat sheet with section-by-section pitfalls and a pre-sign checklist; the DOCX is the blank template, ready to adapt.
Scenario: adult client, PTSD, cognitive processing therapy, session 7 of a planned 12, community mental health clinic. All details are fictional.
Client: J.M., 37 · Date: 07/09/2026 · Session: 7 · Service: Individual psychotherapy, 53 min, in office · Start/stop: 15:03 to 15:56
B: On time, casually dressed, cooperative. Affect constricted early in session, more expressive by the close. Reported nightmares twice this week, down from four, and one avoided grocery trip completed with moderate anxiety. PCL-5 today: 38 (down from 52 at intake). Speech normal rate; no psychomotor agitation. Denied suicidal ideation and self-harm urges.
I: Cognitive processing therapy, session 7 content: reviewed the completed challenging-questions worksheet on the stuck point "I should have stopped it"; introduced patterns-of-problematic-thinking worksheet; Socratic questioning targeting self-blame; assigned one written account review. All interventions serve Goal 1 (reduce trauma-related self-blame and avoidance).
R: Client completed the worksheet fully for the first time and generated two alternative statements with minimal prompting, stating "maybe there wasn't a right move that night." Became tearful during the account discussion but stayed engaged and used grounding without cueing. Avoidance decreasing (grocery trip completed); nightmare frequency halved. No change yet in sleep-onset difficulty.
P: Continue weekly CPT; next session: patterns-of-problematic-thinking review and second written account. Homework: daily worksheet practice, one additional avoided-situation task. Re-administer PCL-5 at session 9. Coordinate with prescriber regarding ongoing sleep-onset difficulty. Next appointment 07/16/2026.
This sample is fictional and for educational purposes. It does not describe a real patient.
Writing these after every session? BastionGPT drafts complete notes from bullets, dictation, or a transcript.
Generate a note from bulletsA BIRP note is part of the designated record set: clients can request it, payers can audit it, and other providers may rely on it. Keep private process reflections in separately maintained psychotherapy notes with their own authorization rules. And do not rely on the BIRP label for payer acceptance one way or the other: the format is convention. California's Medi-Cal behavioral health policy now says it will not enforce format requirements beyond its stated content rules, a useful marker of where behavioral-health documentation policy is heading.
What reviewers do enforce is content and authentication. Medicare's psychotherapy coverage policy wants the interventions described, the patient's participation and reaction, progress toward goal-oriented outcomes, and the rationale for plan changes, and it says a bare "supportive psychotherapy given" is not enough. For psychiatrists billing same-day E/M plus psychotherapy, CMS billing guidance requires the two services to be significant and separately identifiable, and E/M time cannot be counted as psychotherapy time. On signatures, Medicare's signature guidance is current enough to address AI directly: if AI or a scribe transcribes the entry, the clinician must still sign to authenticate it, and OIG audits have rejected pasted images of signatures. CMS's records rule adds a 7-year maintenance-and-access expectation for covered ordering and referral documentation.
On retention, the rules differ even inside one country: HIPAA sets no patient-chart period (state law governs), Ontario's college expects at least 10 years while Québec's psychologist regulation sets at least 5 years from the last professional service, and Australia's Psychology Board code sets 7 years, or until age 25 for clients who were minors. Check your own jurisdiction before adopting any single number.
The audit record is blunt about how psychotherapy documentation fails. In a provider-level OIG audit, 111 of 120 sampled claims were noncompliant, with therapeutic maneuvers not specified, notes that did not support the services billed, no documented expectation of improvement, and, on 109 claims, notes "signed" with pasted images of signatures. Medicare's psychotherapy coverage policy singles out vague entries like "supportive psychotherapy given" as inadequate, and state behavioral-health training teaches that a progress note must stand alone and keep the golden thread from assessed need to next step. The BastionGPT Clinical Advisory Board sees the same patterns most often in BIRP note reviews:
| Aspect | United States | Canada | Australia |
|---|---|---|---|
| Status | Convention; California's Medi-Cal policy is explicitly format-neutral, and Medicare regulates content, signatures, and access rather than headings | Convention; provincial colleges make record content enforceable (Ontario CRPO; Québec regulation for psychologists) | Convention; Psychology Board Code of Conduct (from 1 Dec 2025) and Ahpra expectations govern record quality |
| Terminology | BIRP note, BIRP progress note; GIRP and SIRP are sibling formats | Clinical record, session note | BIRP with the local spelling Behaviour, Intervention, Response, and Plan; case note |
| What changes | Intervention-response detail, same-day E/M separation, signature authentication (including AI-transcribed notes) | Ontario: dated, attributable entries and a 10-year floor; Québec: prescribed record contents with a 5-year floor | Records made at the time of events; continuity-of-care detail; Better Access reporting sits at the episode level |
| Retention | No HIPAA chart rule; state law governs; Medicare expects 7 years for covered ordering and referral documentation | Ontario: at least 10 years from last interaction, or from the client's 18th birthday; Québec: at least 5 years from the last professional service | 7 years since last entry; until age 25 for clients under 18 (Psychology Board Code) |
The intervention-response thread reads well to reviewers in all three countries. What changes is the regulatory layer around it, so anchor retention and signature practices to your own jurisdiction, not to the format.
BastionGPT is specifically trained, tuned, and clinically tested on BIRP notes.
BastionGPT drafts, you review and sign, which is exactly what Medicare's signature guidance requires for AI-assisted notes. See how clinicians use it day to day on the AI therapy notes page.
Many BastionGPT users report saving more than 90 minutes per day on documentation.
HIPAA-compliant with a signed BAA on every plan. Your data is never used to train models. BastionGPT drafts, you review and sign.
All three are progress-note conventions. SOAP splits the client's report from your observations; DAP merges them into one Data section; BIRP organizes the note around the intervention-and-response loop. Choose BIRP when showing what you did and how the client responded matters most, not because any payer requires it.
How the client participated, how they reacted to each intervention, and what changed or did not change in symptoms, behavior, or goal progress. Medicare's psychotherapy coverage policy asks for exactly that: participation, reaction to the session, and progress toward goal-oriented outcomes. An honest "no change yet" is better documentation than silence.
No source we reviewed shows a payer requiring BIRP by name, and California's Medi-Cal behavioral health policy is now explicitly format-neutral, with CalAIM county guidance stating the old BIRP/GIRP/SIRP/SOAP choices are no longer required. What payers enforce is content: interventions described, response documented, plan linkage, time support, and authenticated signatures.
Sibling formats that swap the first section: GIRP leads with the Goal being worked, SIRP with the Situation, and both keep Intervention, Response, Plan. Public behavioral-health systems have historically treated BIRP, GIRP, SIRP, and SOAP as interchangeable structures for the same underlying record.
Usually not. HIPAA's psychotherapy-notes category excludes diagnosis, treatment plan, symptoms, prognosis, progress, and session timing, the working content of a BIRP note. A BIRP note kept in the chart is a progress note in the standard record, and labeling it otherwise does not change its access and disclosure status.
You do. Medicare's signature guidance says that when AI or a human scribe transcribes an entry, the responsible clinician must still sign the note to authenticate it, and OIG auditors have rejected pasted images of signatures on psychotherapy claims. That is why BastionGPT is built as draft-and-review: it drafts, you review and sign.
CMS billing guidance requires the two services to be significant and separately identifiable, and time spent on E/M activities cannot be counted as psychotherapy time. In BIRP terms: keep the medication or medical work visibly separate from the psychotherapy content, and record psychotherapy time on its own.
There is no universal rule. HIPAA sets no patient-chart retention period, so US state law governs, with Medicare expecting 7 years for covered ordering and referral documentation. Ontario's college expects at least 10 years, Québec's psychologist regulation at least 5 years from the last professional service, and Australia's Psychology Board code 7 years, or until age 25 for clients who were minors.
Yes. Paste a transcript, dictate, or give it bullets, and it produces a structured BIRP draft for your review, with the intervention-response thread intact. It can also convert notes between BIRP, SOAP, DAP, and narrative structures. BastionGPT is HIPAA-compliant with a signed BAA on every plan, and your data is never used to train models.
The compliance claims on this page trace to these authorities, last verified July 2026:
Educational content, not legal or billing advice. Sample notes are fictional. Follow your organization's policies and your board, payer, and jurisdiction requirements.