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Run: Occupational Therapy Discharge Summary

An occupational therapy discharge summary for documenting ADL and IADL progress, equipment issued, and home recommendations at the end of care. Use it to clo...

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Discharge Overview

Patient Identifier (required)

Enter the internal patient identifier or medical record number used by your organization. Do not enter unnecessary PII.

Discharge Date (required)

Episode Start Date (required)

Reason for Discharge (required)

If Other, specify reason

Functional Status Change

Baseline Functional Status (required)

Briefly summarize the patient's starting level of function for ADLs and IADLs at evaluation.

Discharge Functional Status (required)

Summarize current performance at discharge, including assistance level, safety, and independence.

Functional Change Summary (required)

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.

Yes No N/A

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 (required)

Include recommendations for safety, supervision, activity pacing, and environmental modifications.

Home Exercise or Activity Program Provided

Yes No N/A

Follow-Up Recommended (required)

If Other, specify follow-up

Patient/Caregiver Education

Summarize education provided, including precautions, strategies, and return precautions if applicable.

Clinician Attestation

Clinician Name (required)

Credentials (required)

Enter professional credentials, such as OTR/L or COTA/L.

Attestation (required)

I attest that this discharge summary accurately reflects the services provided and the patient's status at discharge.

Yes No N/A

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