Daily Progress note
Occupational Therapy
Acute Daily Note Date: _________ Diagnosis: _____________________________
Precautions/Weight Bearing Status: ______________________
Pain Level: ____/10 ____________________________________
AM Session Time: ____:_____ to ____:____ Minutes: Group: ________ Individual: _______
PM Session Time: _____:_____ to ____:____ Minutes: Group: ________ Individual: _______
Patient instructed/educated on the following topics…./ Progress toward goals is as follows…
□ Topics (circle) Pain Control Safety Precautions Transfers DME/AE Sex with Precautions Orthopedic Other _________________
□ Patient verbalizes/applies _______________ precautions with __________ verbal/tactile cues.
□ Endurance: Tolerates __________ minutes of light/moderate activity with _________ breaks.
□ Oral/Facial Hygiene I S CGA Min A Mod A Max A D __________________________
□ UB self care I S CGA Min A Mod A Max A D _________________________________
□ LB self care I S CGA Min A Mod A Max A D ___________________________________
□ Toilet transfer I S CGA Min A Mod A Max A D ______________________
□ Chair transfer I S CGA Min A Mod A Max A D ______________________
□ Bed transfer I S CGA Min A Mod A Max A D ______________________
□ Tub/shower transfer I S CGA Min A Mod A Max A D ______________________
□ Car transfer I S CGA Min A Mod A Max A D ______________________
□ Home/Kitchen mobility I S CGA Min A Mod A Max A D ____________________
□ Meal prep I S CGA Min A Mod A Max A D ______________________
□ Energy Conservation/Work Simplification
Acute Daily Note Date: _________ Diagnosis: _____________________________
Precautions/Weight Bearing Status: ______________________
Pain Level: ____/10 ____________________________________
AM Session Time: ____:_____ to ____:____ Minutes: Group: ________ Individual: _______
PM Session Time: _____:_____ to ____:____ Minutes: Group: ________ Individual: _______
Patient instructed/educated on the following topics…./ Progress toward goals is as follows…
□ Topics (circle) Pain Control Safety Precautions Transfers DME/AE Sex with Precautions Orthopedic Other _________________
□ Patient verbalizes/applies _______________ precautions with __________ verbal/tactile cues.
□ Endurance: Tolerates __________ minutes of light/moderate activity with _________ breaks.
□ Oral/Facial Hygiene I S CGA Min A Mod A Max A D __________________________
□ UB self care I S CGA Min A Mod A Max A D _________________________________
□ LB self care I S CGA Min A Mod A Max A D ___________________________________
□ Toilet transfer I S CGA Min A Mod A Max A D ______________________
□ Chair transfer I S CGA Min A Mod A Max A D ______________________
□ Bed transfer I S CGA Min A Mod A Max A D ______________________
□ Tub/shower transfer I S CGA Min A Mod A Max A D ______________________
□ Car transfer I S CGA Min A Mod A Max A D ______________________
□ Home/Kitchen mobility I S CGA Min A Mod A Max A D ____________________
□ Meal prep I S CGA Min A Mod A Max A D ______________________
□ Energy Conservation/Work Simplification