OCCUPATIONAL THERAPY ASSESSMENT DATA SET. Name: Therapist: SS#:. Service Cood/Guardian: DOB: Case Manager: Date(s) of Eval: Agency: Background Information. |
Equipment in use (if any):. Manual Wheelchair. Powered Wheelchair. Elbow Gaiter. RT Wrist Splint. LT Wrist Splint. RT Hand Splint. LT Hand Splint. |
No hazards indentified. ☐ No running water, plumbing. ☐ No gas / electric appliance. ☐ Steps / Stairs: ☐ Lack of fire safety devices. |
21 июл. 2024 г. · Occupational therapy (OT) evaluation is a systematic process used to assess an individual's ability to perform daily activities and participate in meaningful ... |
Please fill in your name and address and deliver this form to a (registered) Occupational Therapist or community agency supervisor who has supervised you on ... |
Information recorded during this assessment may be shared with others involved in your care and/or treatment plan. Do you consent to information recorded during ... |
Include NEW job tasks and NEW residence. Performance Environments: Include home and day/work environmental observations. FUNCTIONAL STATUS IN OT INTERVENTION ... |
7 мар. 2019 г. · I hereby request and consent to forms of Occupational therapy, I have been informed about the following: a description of treatment, which body ... |
To be completed by an occupational therapist qualified to conduct driver assessments. Please print clearly using BLOCK letters or type in sentence case. Learner ... |
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