The Occupational Therapy Assessment Form by s10.ai is an all-encompassing template crafted for occupational therapists to thoroughly evaluate a client's functional abilities and requirements. This form meticulously records client details, such as medical history, living conditions, and support networks, while also assessing motor skills, sensory needs, and daily living skills. It offers a comprehensive perspective on the client's strengths and areas needing improvement. Perfect for therapists working with clients under the NDIS, this template guarantees detailed documentation and supports the creation of tailored therapy plans. Implement this form with s10.ai to optimize assessments and elevate client care.
Organized sections for comprehensive clinical documentation
Example of completed documentation using this template
Occupational Therapy Assessment FormCLIENT DETAILS- Name: John Doe- Date of initial assessment: 2023-10-15- Date of birth: 1985-06-20- Address: 123 Main Street, Springfield- Phone number: (555) 123-4567- Email address: johndoe@example.com- Next of Kin name and number: Jane Doe, (555) 987-6543- Persons present during Ax: Jane Doe- Funding body if applicable: Medicare- Medical and health history: History of arthritis and hypertension- Medications: Lisinopril 10mg daily, Ibuprofen 200mg as needed- GP details: Dr. Sarah Smith, (555) 321-7654- Living Situation: Lives alone in a single-story home- Current community services / social supports and/or allied health input: Weekly physiotherapy sessions- Referrer and reason: Dr. Sarah Smith, referred for assessment of daily living skillsFor FCA’s:- Level of schooling: Bachelor's degree in Engineering- Employment history: Former mechanical engineer, retired- Social story, family: Widowed, two adult children- Supports that aren't official: Neighbors assist with grocery shopping- NDIS paid for supports: NoneNDIS INFORMATION- NDIS number: 123456789- Plan manager contact details: Plan Manager Inc., (555) 654-3210- Support Coordinator details: Emily Johnson, (555) 432-1098- Plan dates: 2023-01-01 to 2023-12-31Other relevant info:- Perceived strengths: Strong problem-solving skills- Things wanting to work on: Improve mobility and balance- Fine and gross motor skills: Difficulty with fine motor tasks, gross motor skills moderately impaired- Sensory needs: No significant sensory needs- What’s something really important to you that you are wanting to do: Travel independently- Sleep: Reports difficulty falling asleep- Social skills/ friends: Active in local community group- Mobility: Uses a cane for walking- Assistive Technology Used: Cane, grab bars in bathroomCLIENT/PARTICIPANT - Reports- Height (Self/carer reported): 175 cm- Weight (Self/carer reported): 80 kg- Hand dominance: Right- Sitting tolerance/balance (Observed): Good- Standing tolerance & static balance (Observed): Fair- Walking tolerance & dynamic balance (Observed): Limited to 100 meters- Sit to stand transfers / other transfers (Observed): Requires minimal assistance- Car transfer: Independent- Current Assistive technology in use (Self/carer reported + observed): Cane, grab bars- Number of falls in last 6 months (Self/carer reported): 2- Vision (Self/carer reported): Wears glasses- Hearing (Self/carer reported): Normal- Cognitive capacity (Self/carer reported + observed + Ax): Intact- Pressure injury or ulcer history (Self/carer reported): None- Oedema issues (Self/carer reported + observed): Mild in lower extremities- Recent hospitalisations in last month: None- Upper limb function (Observed): Adequate- Sensory issues or concerns (Self/carer reported): None- Communication issues (Self/carer reported + observed): None- Behavioural issues (Self/carer reported + observed): None- Leisure activities/previous occupation: Enjoys gardening, former engineer- Informal supports (Self/carer reported): Neighbors- Community access (Self/carer reported): Limited due to mobility- Received previous OT input/assessment?: Yes, last yearHOME- Type of home: Single-story house- Main entry when entering/leaving home: Front door with ramp- Topography of block: Flat- Presentation of property: Well-maintained- Living situation: Lives alone- Time at current property: 10 years- Ownership of home: Owned- Landlord details if applicable: N/APre-trial powered mobility device (PMD) questionnaire:- Are PMD users considered motorists or pedestrians?: "Pedestrian"- At what speed should a PMD be driven?: "Maximum speed 10km p/hr"- Where should a PMD be used or driven?: "Devices should be driven on the footpath with travel on the road only permitted if a suitable footpath is unavailable"- What position on the footpath should a PMD maintain?: "They must keep to the left and give way to other pedestrians."- If you have to travel on the road, should you be facing the traffic, or should it be behind you?: "If there is no footpath or nature strip, walk so you’re facing oncoming traffic."- When approaching a road, what are three things you will need to consider before crossing?: Oncoming traffic, speed, and curb height- In what position should the PMD be, prior to crossing kerb?: "Straight on/facing curb"- Can you identify three potential problems or obstacles you may face on a footpath?: Uneven surfaces, low-hanging branches, and narrow pathways- How can you make yourself visible to other pedestrians and drivers?: "Flag, coloured clothing, lighting"Self-care Activities:- Undressing/dressing: Self-reported, Minimum Assistance- Showering/drying: Self-reported, Moderate Assistance- Grooming: Self-reported, Independent- Feeding: Self-reported, Independent- Toileting: Self-reported, IndependentDaily Living Skills:- Meal prep & cooking: Self-reported, Shares task with others/some assistance required- Making cup of coffee/tea: Self-reported, Independent- Dish washing: Self-reported, Shares task with others/some assistance required- Cleaning: Self-reported, Dependent- Grocery shopping: Self-reported, Dependent- Making/stripping bed: Self-reported, Shares task with others/some assistance required- Laundry: Self-reported, Shares task with others/some assistance required- Ironing: Self-reported, Dependent- Financial management: Self-reported, Independent- Medication management: Self-reported, Independent- Letterbox and mail management: Self-reported, Independent- Wheelie bins and rubbish management: Self-reported, Shares task with others/some assistance required- Pet care: Self-reported, Independent- Lawn and garden maintenance: Self-reported, Dependent- Managing needs of children: N/A- Phone use / appt making: Self-reported, Independent- Driving / Public transport: Self-reported, DependentCLIENT GOALS:- Improve mobility and balance- Increase independence in daily living activities- Enhance social participationPROGRESS NOTES:- Client has shown improvement in balance with the use of a cane- Participating in weekly physiotherapy sessions- Engaging in community activities with assistance
Key advantages of using this template in clinical practice
Common questions about this template and its usage