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Run: PT Discharge Summary and Functional Status

Document a physical therapy discharge summary, final functional status, goal attainment, outcome measure changes, and the home exercise program in one struct...

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Patient and Episode Information

Patient Identifier (required)

Use the internal medical record number or other approved identifier. Do not enter SSN or other unnecessary PII.

Episode Start Date (required)

Discharge Date (required)

Discharge Setting (required)

Discipline (required)

Discharge Reason and Status

Reason for Discharge (required)

Completed Plan of Care? (required)

Discharge Summary (required)

Brief narrative of the episode outcome, including response to treatment and functional change.

Current Functional Limitations at Discharge

Goal Attainment

Overall Goal Status (required)

Goals Met Summary

Summarize the measurable goals achieved during the episode.

Goals Not Met or Partially Met

Explain barriers, remaining deficits, or why goals were not fully achieved.

Goal-by-Goal Status (required)

Add each discharge goal and its final status.

Outcome Measures and Functional Status

Outcome Measure Name (required)

Baseline Score

Enter the initial score from the start of care if available.

Final Score (required)

Higher Score Indicates (required)

Functional Status Change Summary (required)

Describe the change in mobility, pain, strength, endurance, balance, or activities of daily living from baseline to discharge.

Assistive Device Status at Discharge

Home Program and Follow-Up

Home Program Provided? (required)

Home Exercise Program Details

Include exercises, dosage, precautions, and patient education provided at discharge.

Follow-Up Recommendations

Include referral recommendations, return precautions, or instructions for re-evaluation if symptoms worsen.

Patient Understanding of Discharge Instructions

Clinician Attestation

Clinician Name (required)

Credentials (required)

Signature (required)

Attestation (required)

Yes No N/A

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