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Run: Therapy Discharge Summary

Therapy Discharge Summary template for documenting episode outcome, goals met, residual deficits, equipment recommendations, home program, and follow-up plan...

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Episode and Clinician Information

Patient Identifier (required)

Enter the patient chart ID or medical record number. Do not enter a full SSN or other unnecessary PII.

Therapy Discipline (required)

Discharge Date (required)

Clinician Name (required)

Discharge Setting (required)

Discharge Reason and Episode Outcome

Reason for Discharge (required)

Overall Episode Outcome (required)

Summary of Progress (required)

Briefly summarize functional gains, response to treatment, and notable changes since start of care.

Goal Attainment and Functional Status

Goals Met (required)

Functional Status at Discharge (required)

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 (required)

Home Program Summary

Summarize exercises, precautions, frequency, and patient/caregiver education provided.

Follow-Up, Education, and Clinician Attestation

Follow-Up Recommended (required)

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 (required)

Yes No N/A

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Email (required)

Your name (optional)

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