Therapy Discharge Summary

End-of-episode summary form for documenting discharge status, goals met, residual deficits, equipment recommendations, home program, and follow-up planning during transition from therapy.

Episode and Clinician Information

• Patient Identifier
  Enter the patient chart ID or medical record number. Do not enter a full SSN or other unnecessary PII.
• Therapy Discipline
• Discharge Date
• Clinician Name
• Discharge Setting

Discharge Reason and Episode Outcome

• Reason for Discharge
• Overall Episode Outcome
• Summary of Progress
  Briefly summarize functional gains, response to treatment, and notable changes since start of care.

Goal Attainment and Functional Status

• Goals Met
• Functional Status at Discharge
  Describe current mobility, ADL/IADL performance, communication, swallowing, or other relevant function based on discipline.
• Residual Deficits
  Document remaining limitations, precautions, or areas needing continued support.
• Outcome Measure Name
  Optional: enter the standardized outcome measure used, if applicable.
• Outcome Measure Score
  Optional: enter the final score or change score, if applicable.

Equipment, Adaptive Devices, and Home Program

• Equipment or Adaptive Devices Recommended
• Equipment Details
  Specify sizing, setup, training completed, or vendor/family instructions as needed.
• Home Program Provided
• Home Program Summary
  Summarize exercises, precautions, frequency, and patient/caregiver education provided.

Follow-Up, Education, and Clinician Attestation

• Follow-Up Recommended
• Follow-Up Details
  Include discipline, timeframe, referral source, or monitoring instructions if follow-up is needed.
• Patient or Caregiver Education
  Document key education topics, teach-back, and any communication with the care team.
• Clinician Attestation