Adaptive Equipment Issue and Training Log

Document adaptive equipment issued, fit/selection, patient training, and return demonstration for items such as reachers, dressing aids, and bathing equipment.

Visit and Patient Context

• Date of Visit
• Service Setting
• Patient Identifier
  Use the facility-approved medical record number or encounter ID. Do not enter unnecessary PII.
• Referring Service or Discipline

Equipment Issued

• Equipment Type
• Equipment Details
  Include size, model, quantity, or other relevant specifications only if needed for documentation.
• Quantity Issued
• Issue Method

Fit and Selection

• Was the equipment fit or selection appropriate for the patient?
• Fit or Selection Notes
  Document any sizing concerns, contraindications, home environment limitations, or replacement needs.
• Replacement or Alternate Equipment Needed?

Patient Training and Demonstration

• Training Provided?
• Training Topics Covered
• Patient Performed Return Demonstration?
• Patient Understanding
• Training Notes
  Include cues provided, safety reminders, barriers to learning, or caregiver involvement if applicable.

Follow-Up and Attestation

• Follow-Up Needed?
• Follow-Up Plan
• Documented By
  Enter the staff member's name or identifier per facility policy.
• I confirm the equipment issue, training, and return demonstration were documented accurately.