M & M HOME CARE: THERAPY DISCHARGE SUMMARY

1Treatment > 2Billing & Signature > 3Review Your Entry
DISCIPLINE
PATIENT NAME: PATIENT NAME: First Last
PATIENT DOB: PATIENT DOB: / MM / DD YYYY
PATIENT DOI: PATIENT DOI: / MM / DD YYYY
INITIAL VISIT DATE: INITIAL VISIT DATE: / MM / DD YYYY
DISCHARGE DATE: DISCHARGE DATE: / MM / DD YYYY
COURSE OF REHABILITATION
***** was seen by occupational/physical/speech/massage therapy multiple times since the initial OT/PT/SLP/MT evaluation on ****. Occupational/Physical/Speech/Massage therapy has focused on the following: *******. Client is assessed to have a significant improvement in ***. She/He continues to demonstrate ongoing issues with **** which are being managed by caregiver following skilled instruction and training.

Note how patient's participation and attendance has been

Note any barriers towards therapy (ex: inconsistent attendance, attention/distractibility, etc.)

Clearly note improvements achieved through your therapy with the patient

CLEARLY STATE REASON FOR DISCHARGE
STATUS OF GOALS AT DISCHARGE
STATUS OF THERAPY GOALS AT DISCHARGE:

'Not applicable' selection is for massage therapist use only.
IF APPLICABLE, BRIEFLY DESCRIBE PROGRESS TOWARDS GOAL AREAS

Ex: Client achieved LTG as evidenced by utilizing external compensatory strategies to accurately pack own medications at modified independent level. This is a significant improvement from the previous reporting period where client required 25% assistance from this clinician to complete task with 100% accuracy.
RECOMMENDATIONS
RECOMMENDED SERVICES

RECOMMENDED SERVICES Occupational Therapy Physical Therapy Speech Therapy Massage Therapy Dietitian Nursing Home Health Aide None at this time Other Other
JUSTIFICATION FOR OTHER RECOMMENDED SERVICES:
MISCELLANOUS RECOMMENDATIONS

MISCELLANOUS RECOMMENDATIONS Home Exercise Program Continuation of External Strategy Tools Continuation of Internal Strategy Tools Use of Prescribed Adaptive and/or Durable Equipment OT Home Modification Evaluation OT Attendant Care Assessment PT Wheelchair Fitting/Assessment None at this time Other Other
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M & M HOME CARE: THERAPY DISCHARGE SUMMARY

M & M HOME CARE: THERAPY DISCHARGE SUMMARY

COURSE OF REHABILITATION

STATUS OF GOALS AT DISCHARGE

RECOMMENDATIONS