Occupational Therapy Discharge Summary

A discharge form for occupational therapy to summarize ADL and IADL goal achievement, functional status change, equipment issued, and home recommendations at the end of care.

Discharge Overview

• Patient Identifier
  Enter the internal patient identifier or medical record number used by your organization. Do not enter unnecessary PII.
• Discharge Date
• Episode Start Date
• Reason for Discharge
• If Other, specify reason

Functional Status Change

• Baseline Functional Status
  Briefly summarize the patient's starting level of function for ADLs and IADLs at evaluation.
• Discharge Functional Status
  Summarize current performance at discharge, including assistance level, safety, and independence.
• Functional Change Summary
  Describe the measurable change in function since evaluation, including gains, plateaus, or regressions.

ADL and IADL Goal Attainment

• ADL Goals Met
  Select all ADL goals that were achieved by discharge.
• IADL Goals Met
  Select all IADL goals that were achieved by discharge.
• Goals Not Met or Partially Met
  List any goals that were not met or only partially met, and briefly explain why.
• Barriers to Progress
  Select factors that affected progress toward goals.
• If Other, specify barrier

Equipment and Adaptive Devices

• Equipment Issued
  Select all equipment or adaptive devices issued at discharge.
• Training Provided
  Check if the patient and/or caregiver received training on safe use of issued equipment.
• Equipment Effectiveness
  Describe whether the equipment improved safety, independence, or task performance.
• Additional Equipment Recommended
  List any additional devices or home modifications recommended but not issued.

Home Recommendations and Follow-Up

• Home Recommendations
  Include recommendations for safety, supervision, activity pacing, and environmental modifications.
• Home Exercise or Activity Program Provided
• Follow-Up Recommended
• If Other, specify follow-up
• Patient/Caregiver Education
  Summarize education provided, including precautions, strategies, and return precautions if applicable.

Clinician Attestation

• Clinician Name
• Credentials
  Enter professional credentials, such as OTR/L or COTA/L.
• Attestation
  I attest that this discharge summary accurately reflects the services provided and the patient's status at discharge.