Free Acute Care Physical Therapy Evaluation Template
Acute Care Physical Therapy Evaluation
[Your Company Name]
Date: [Date]
Introduction:
Welcome to the Acute Care Physical Therapy Evaluation. This evaluation is designed to assess a patient's physical function, mobility, strength, and range of motion in the acute care setting. The information gathered from this evaluation will help guide the development of an appropriate treatment plan to promote the patient's recovery and overall well-being.
Background:
In the acute care setting, patients often require physical therapy to address impairments related to injury, illness, or surgery. This evaluation focuses on assessing the patient's current physical status, including their ability to perform basic functional tasks, mobility, muscle strength, and joint flexibility. It is crucial to conduct a thorough evaluation to identify any deficits or limitations that may impact the patient's ability to participate in daily activities and to determine the most effective interventions to optimize their recovery.
Patient Information:
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Name: __________________________
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Age: ___________________________
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Gender: _________________________
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Date of Evaluation: ______________
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Medical Diagnosis/Condition: _________________________________________
Evaluation Criteria:
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Functional Mobility: Assess the patient's ability to perform basic functional tasks such as sitting, standing, walking, and transferring.
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Range of Motion (ROM): Evaluate the range of motion of major joints including shoulders, elbows, wrists, hips, knees, and ankles.
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Muscle Strength: Grade muscle strength using manual muscle testing or functional tests to assess strength in various muscle groups.
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Balance and Coordination: Assess the patient's balance and coordination during static and dynamic activities.
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Gait Analysis: Analyze the patient's walking pattern including step length, stride length, cadence, and symmetry.
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Pain Assessment: Evaluate the presence and severity of pain using a numeric pain scale or visual analog scale.
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Functional Independence Measure (FIM): Utilize the FIM scale to assess the patient's level of functional independence in activities of daily living.
Evaluation Table:
Criteria |
Observation/Measurement |
Findings |
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Functional Mobility |
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Range of Motion |
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Muscle Strength |
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Balance and Coordination |
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Gait Analysis |
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Pain Assessment |
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Functional Independence |
Comments/Feedback:
Please provide any additional comments or feedback regarding the patient's evaluation or concerns related to their physical therapy management. Your input is valuable for developing an effective treatment plan and ensuring the best possible outcomes for the patient.
Additional Feedback and Comment |
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