SIRP notes: a practical guide with examples

The SIRP format organizes the session note into four sections: Situation, Intervention, Response, and Plan. It is the third member of the -IRP family — alongside BIRP notes and GIRP notes — and by far the worst documented. This guide covers what each letter asks for per the one official manual that defines it, with a worked example, an honest comparison against its siblings, and how it meets the record rules you answer to.

Worth saying up front: SIRP has no founding paper, no author, and no standards body behind it. It is not a standard, but a local convention one California county turned into an internal requirement.

Where SIRP comes from (and why nobody knows)

We went looking for an origin and there is none. The oldest document we reached is Marin County, California’s 2017 documentation manual, where the format already appears as something in use; we found no earlier editions. So: not “SIRP originated in Marin County” but “no origin is documented, and Marin is the oldest trace we could verify.”

What is documented is the mandate. Marin County Behavioral Health and Recovery Services’ January 2022 clinical documentation guide does not suggest the format, it requires it — “BHRS requires that practitioners use a SIRP format for notes” — because, it says, the format helps ensure the note meets all its requirements and gives a clear picture of services and client status. A date caution: that is the most recent edition we found, it predates the reform that led other California counties to drop the formats, and we cannot confirm it still stands.

One detail in its abbreviation appendix says more than any origin story: beside “SIRP Situation, Intervention, Response, and Plan” sits “SIP Situation, Intervention, and Plan.” These do not come out of a standards committee.

The four letters, per the Marin manual

S — Situation (and no, it is not the subjective section)

Here is the mistake nearly every online explainer repeats: presenting S as the equivalent of SOAP’s S, “what the client reports.” The manual says the opposite. It asks for a clear notation of the complaint, the condition, and the reasons presented during the session, with two demands that change the section’s meaning: behavioral terms and an assessment of the client, and — verbatim — “This is not a statement of diagnosis but rather a statement of why this session was necessary.” S is not the client’s report: it is a compressed assessment justifying the session.

Second correction: several pages offer “Situation or Symptom” as though two schools existed. In Marin’s two editions — the only manual in our sweep that spells it out — the expansion is Situation. We found no manual expanding S as “Symptom” or “Subjective”; we cannot prove none exists.

Where the ambiguity came from can be reconstructed: in 2017 the prompts under S pointed at presentation and diagnostic validity — hygiene, speech, mood, which impairments are the focus, whether the diagnosis holds; by 2022 Marin had rewritten them toward identity, symptoms, and purpose of contact. The content drifted symptom-ward; the name did not.

I — Intervention

What you did, in descriptive sentences: the skills used to cope, adapt, respond, or problem-solve; reinforcement of new behaviors and strengths; the skills taught, modeled, or practiced. Marin loads into I the clinician’s assessment, “including risk assessment when applicable,” and the recommendations given to the client or family; other manuals locate risk in the plan instead.

That risk clause deserves underlining. When a risk signal appears, the note must show that you carried out an immediate clinical risk assessment under your own protocol and training, what you found, and what your decision rested on — the subject of documenting a suicide risk assessment.

R — Response

How the client responded to your intervention, in behavioral terms, including progress “or lack of progress,” the general response to treatment, and how it was received. Same R as BIRP and GIRP, with the same trap: “client was cooperative” answers nothing; the question is what each thing you did produced.

P — Plan

The clinical decisions about the case: collateral contacts, referrals, follow-up items, homework, treatment meetings to convene. It looks forward; it does not summarize. One detail no online summary carries: Marin ties its late-entry rule to S — after 72 hours, or ten business days if the note requires a co-signature, the clinician writes “late entry” at the start of that first portion.

A complete worked example

A fictional case, in the structure the 2022 guide asks for:

Date: June 22, 2026 · Time: 11:00–11:50 · Modality: in person, office

S — 34-year-old woman in treatment for a depressive episode, ninth session. Nighttime awakenings persist four nights per week, with social withdrawal; declined two invitations. Current functional impairment: one day of work absence. Session scheduled to adjust the pace of behavioral activation given the reported plateau.

I — Reviewed the activity log. Provided psychoeducation on the avoidance–mood link from the behavioral activation model. Modeled and rehearsed breaking tasks into ten-minute steps. Explored risk indicators: denies ideation, plan, and intent. Recommended holding the weekend sleep schedule.

R — Identified the pattern “the less I do, the worse I sleep” on her own. Completed the task-breakdown rehearsal and reported less overload. Partial progress toward Objective 1: two personally valued activities this week, up from one the week before; no change in nighttime awakenings. Skeptical about resuming social contact, negotiated a shorter version.

P — Continue behavioral activation with broken-down tasks; daily sleep log. Next session, evaluate whether the sleep plateau warrants revising Objective 2. Next appointment: September 4.

Three things hold it together: S says why there was a session, not just what the client reported; I names interventions with verbs and records the risk exploration; R documents uneven progress, which is what clinical work looks like.

SIRP vs BIRP and GIRP: what the manuals do not say

A caution the comparison charts omit: no official manual we reviewed compares the formats or advises choosing one. Los Angeles County’s 2024 guide merely lists them as templates. What follows is our reasoning, not manual text.

The three -IRP formats share the Intervention–Response–Plan core; what changes is the door you enter through, and the real asymmetry is width. BIRP’s B is narrow — the behavior observed today — and GIRP’s G is too — the plan goal the session worked. SIRP’s S is wide: presentation, symptoms, identifying context, purpose of contact, and an assessment of impairment — in effect, a mini assessment: comfortable where every session must justify its own necessity, less so when you want the note-to-plan link read first, which is what GIRP forces. For something leaner in private practice, compare DAP vs SOAP; and if your S runs empty week after week, what is missing is a treatment plan with verifiable goals.

How common SIRP actually is, and what regulators audit

Not very. Outside Marin, the only institutional appearance we found is Los Angeles County, and there as a template in retreat: its 2024 guide states that BIRP, GIRP, SIRP, and SOAP “are no longer required by DHCS,” keeping templates only for CARF or Joint Commission purposes. Neighbors use something else: Alameda says the BIRP format “in general” meets its content standard, Solano adopted it as its standardized method, and Connecticut publishes a tip sheet dedicated to GIRP. None names SIRP. Our sweep is not exhaustive, but the picture is clear: a local convention.

And the point that matters: the acronym is not what gets audited. California’s BHIN 23-068 (November 2023) lists seven content elements for the individual progress note — type of service, date, duration, location, name and signature with date, how the service addressed the person’s behavioral-health needs, and a summary of next steps — and names no format. North Carolina Medicaid does the same from the payer side: Clinical Coverage Policy 8C, amended January 2025, requires the purpose of the contact tied to plan goals, the interventions performed, and the “effectiveness of the intervention(s) and the beneficiary’s response or progress toward goal(s)” — the I and R of any -IRP note, as reimbursement conditions rather than a format.

Does note order matter at all? The only decent evidence we located comes from another field: Belden et al. (2017) compared the SOAP note against three APSO prototypes with primary-care physicians and found better accuracy and usability; the speed advantage, though, came from the collapsible prototypes, not from reordering alone. Nothing there is about psychotherapy, BIRP, GIRP, SIRP, or outcomes: only that how a note is presented changes how fast a reader finds the information.

SIRP and the record rules you answer to

No regulator we found mandates SIRP, and none needs to — record rules commonly leave the form to you. Mexico’s clinical-record standard, NOM-004-SSA3-2012, is a clean example: numeral 5.13 lets providers in the public, social, and private sectors “elaborar formatos para el expediente clínico, tomando en cuenta los requisitos mínimos establecidos en esta norma” — design their own forms, taking the norm’s minimum requirements into account. The label is yours; the minimum content is not.

That minimum sits in numeral 6.2: evolution and update of the clinical picture, vital signs as considered necessary, relevant results of prior studies, diagnoses or clinical problems, prognosis, and treatment. The mapping — our analysis, not the norm’s text — is direct: S supplies the clinical evolution and much of the clinical problems, since Marin asks for diagnosis and assessment inside it; I and R the treatment and its effects; P the indications. Two gaps remain: prognosis has no slot, and diagnoses are covered only if you genuinely write S as an assessment. Add numeral 5.10 — date, time, full name, and signature on every entry — and note that 6.2 is addressed to “el médico”, with 5.16 pulling the psychological progress note into the same regime; what Mexico’s clinical-record standard asks of psychologists covers the rest. If you bill Medicaid or another payer, your state manual or contract defines the equivalent list. This is documentation guidance, not legal advice: verify the rules where you practice.

Common mistakes in SIRP notes

Writing S as if it were SOAP’s S. The manual asks for behavioral terms and an assessment, not a transcript of what the client reported. If your S fits entirely inside “client reports that…”, half is missing.
An S that does not justify the session. It must say why this session was necessary; if it is interchangeable with last month’s, it does not.
Interventions without a verb. “Anxiety was addressed” documents nothing: action verb, named skill, named model.
Leaving out the risk assessment where it applies. The manual places it inside I; naming a risk signal without the assessment that followed is the costliest gap to explain.
Trusting the acronym. SIRP has no slot for prognosis: check your format against what your rule requires.

The acronym matters less than what holds it up

California’s notice and Mexico’s numeral 5.13 say the same thing: outside Marin, nobody audits your acronym. What is audited is that a note exists for every encounter, that it says why there was a session, what you did, what it produced and what comes next, and that it carries date, time, name, and signature. SIRP produces that, with a virtue of its own: it forces you to justify the session before narrating it.

The hard part is never understanding the format: it is sustaining it with twenty clients a week. gesell.ai drafts the note from your session record in SOAP, DAP, BIRP, or GIRP format; and since the -IRP variants share the Intervention–Response–Plan core, a BIRP or GIRP draft carries almost everything a SIRP note needs, leaving the first section to rewrite as an assessment. You review and adjust every draft: the final note is yours.