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Occupational Therapy Specialist
15-20 minutes

Evaluation of Functional Capacity

The Functional Capacity Assessment template by s10.ai is an all-encompassing tool designed for occupational therapists to thoroughly evaluate a client's capability to engage in daily activities. This essential template assesses physical, cognitive, communication, and social capacities, offering a comprehensive overview of a client's functional abilities. It is particularly beneficial for developing customized support plans for individuals with disabilities or those recuperating from injuries. When integrated with s10.ai, this template guarantees precise and efficient documentation, enhancing care planning and service recommendations. Perfect for occupational therapists, this template supports the delivery of personalized interventions and support services.

2,933 uses
4.5/5.0
J
Jordan Mitchell
Template Structure

Organized sections for comprehensive clinical documentation

Client Details:
- [Client's full name] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [Date of birth] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [NDIS participant number] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Date of Evaluation:
- [Date of assessment] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Evaluator Details:
- [Assessor's full name] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [Assessor's professional title] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [Assessor's contact details] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Referral Purpose:
- [Reason for referral] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Historical Context:
- [Client's medical history] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [Client's social history] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [Client's current living situation] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Functional Capacity Evaluation:
- [Describe client's physical capacity] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [Describe client's cognitive capacity] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [Describe client's communication capacity] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [Describe client's social and emotional capacity] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [Describe client's daily living skills] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Conclusions and Suggestions:
- [Summary of assessment findings] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [Recommendations for support and services] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Evaluator's Endorsement:
- [Assessor's signature] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [Date of signature] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Sample Clinical Note

Example of completed documentation using this template

Client Information:
- John Doe
- 12/05/1985
- NDIS123456789
Assessment Date:
- 15/09/2025
Assessor Information:
- Dr. Jess Spencer
- Occupational Therapist
- jess.spencer@s10.ai
Reason for Referral:
- To evaluate the client's functional capacity for daily living tasks and suggest suitable support services.
Background Information:
- John has a history of traumatic brain injury from a car accident five years ago.
- He resides alone in a one-bedroom apartment and receives weekly visits from a caregiver.
Functional Capacity Assessment:
- John shows limited physical capacity, with decreased strength and coordination in his right arm.
- Cognitive capacity is impaired, with challenges in memory retention and problem-solving.
- Communication capacity is sufficient, though John occasionally has difficulty with word retrieval.
- Social and emotional capacity is stable, but John reports feelings of isolation.
- Daily living skills are compromised, necessitating assistance with meal preparation and personal hygiene.
Summary and Recommendations:
- John faces significant challenges in physical and cognitive areas, affecting his daily living skills.
- It is recommended that John receives occupational therapy twice a week, along with ongoing caregiver support for daily activities.
Assessor's Signature:
- Jess Spencer
- 15/09/2024
Clinical Benefits

Key advantages of using this template in clinical practice

  • This comprehensive clinical template is designed to streamline the documentation process for healthcare professionals conducting functional capacity assessments. By integrating high-search healthcare and clinical keywords, this template ensures that clinicians can efficiently capture essential patient information, including medical history, social background, and current living conditions. It facilitates a thorough evaluation of the client's physical, cognitive, communication, social, and emotional capacities, as well as daily living skills. The template also provides a structured format for summarizing assessment findings and formulating personalized recommendations for support and services. By adopting this template, clinicians can enhance the accuracy and consistency of their assessments, ultimately improving patient care outcomes. Explore this template today to optimize your clinical documentation workflow.
Frequently Asked Questions

Common questions about this template and its usage

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Evaluation of Functional Capacity