occupational therapy home visit report template

Occupational Therapy Home Assessment

Unlock independence at home with Occupational Therapy Home Assessment—tailored solutions for a thriving and accessible living space.

By Joshua Napilay on Apr 08, 2024.

Fact Checked by Ericka Pingol.

What is an Occupational Therapy Home Assessment?

An Occupational Therapy Home Assessment is a comprehensive evaluation conducted by occupational therapists to assess an individual's occupational performance within their home environment. Occupational therapy practitioners focus on promoting independence and improving daily living skills, considering occupational performance and physical, cognitive, and emotional well-being factors.

This assessment involves using various tools and strategies to identify areas of concern and develop personalized interventions. During the occupational therapy home assessment, practitioners evaluate functional abilities, assess the home environment, provide recommendations for safety and accessibility, and consider the individual's use of assistive devices.

The assessment may cover fine motor skills, cognitive function, fall risks, energy conservation techniques, other health conditions, and home modifications. Practitioners may also utilize tools like the Mini-Mental State Examination (MMSE) to assess cognitive impairments.

The occupational therapy home assessment aims to enhance the individual's ability to engage in daily routines and activities. Occupational therapists work closely with clients and, in most cases, when applicable, with patients and their family members to identify challenges, remove barriers, and recommend appropriate interventions.

These interventions may include the installation of grab bars, environmental modification of grab bars, adaptive equipment, or environmental changes to improve overall safety and independence. The assessment process involves problem-solving and may vary depending on the individual's health conditions, such as mild cognitive impairment.

Occupational therapy practitioners play a vital role in the interdisciplinary approach to healthcare, collaborating with other agencies and professionals to provide holistic home health care together. The focus is optimizing the home healthcare setting for improved well-being, especially in older adults, by addressing factors like poor lighting and implementing mobility aids.

The efficacy of these interventions is often measured using systematic reviews, randomized controlled trials, and efficacy scales. Occupational therapists aim to enhance their clients' overall quality of life by promoting functional independence and addressing specific challenges related to daily activities. Education and ongoing support are crucial components of occupational therapy's role in services and in ensuring that clients and their families can implement and sustain positive changes in their daily lives.

Printable Occupational Therapy Home Assessment

Download this Occupational Therapy Home Assessment for occupational therapists to assess an individual's occupational performance within their home environment.

Why are home assessments necessary?

Home assessments in occupational therapy are necessary for older adults for several reasons:

• Individualized care: Each person has unique abilities, challenges, and needs. Home assessments allow occupational therapists to tailor their interventions to an individual's home environment, considering layout, accessibility, and personal routines.
• Identifying barriers: Assessments help identify potential barriers within the home environment that may limit an individual's ability to perform daily activities independently. These barriers can include physical obstacles, poor lighting, or the lack of assistive devices.
• Safety concerns: Occupational therapists assess the home for safety hazards that may harm the individual's well-being. This includes evaluating the need for modifications such as grab bars, handrails, or adaptive equipment to prevent falls and accidents.
• Optimizing independence: The primary goal of occupational therapy is to enhance an individual's independence in daily activities. Home assessments help identify areas where individuals may struggle and allow therapists to develop strategies and recommendations to improve functional abilities.
• Customized interventions: Through assessments, occupational therapists can gather information about an individual's physical, cognitive, and emotional capabilities. This information is crucial for creating personalized intervention plans that address specific challenges and build on existing strengths.
• Holistic approach: Home assessments provide a holistic view of an individual's life, considering not only physical abilities but also cognitive function, emotional well-being, and social interactions. This comprehensive understanding enables therapists to offer well-rounded and effective interventions.
• Environmental modifications: The home environment can be modified to suit an individual's needs better. Assessments help identify opportunities for modifications such as rearranging furniture, installing adaptive equipment, or making changes to improve overall accessibility.
• Family involvement: Home assessments often involve family members or caregivers, fostering collaboration and ensuring they understand how to support the individual effectively. This involvement is crucial for the long-term success of the recommended interventions.
• Preventing functional decline: Early identification of challenges and implementation of appropriate interventions can help prevent further decline in functional abilities. Home assessments contribute to proactive and preventative healthcare for individuals with various conditions.
• Promoting well-being: By creating a home environment that supports independence, safety, and engagement in meaningful activities, occupational therapy home assessments contribute to the overall well-being and quality of life of individuals receiving these services.

How does this home assessment work?

The occupational therapy home assessment is a structured process designed to evaluate an individual's ability to perform daily activities within their home environment. The occupational therapy assessment involves the following key steps:

• Referral and initial contact: The process often begins with a referral from a healthcare professional, physician, or other sources. The occupational therapist (OT) establishes initial contact with the individual or caregiver to gather basic information and schedule the assessment.
• Information gathering: The OT gathers medical history, current health condition, concerns, and goals before the assessment. They may also collaborate with other healthcare professionals and review relevant medical records.
• Initial meeting and interview: The OT meets with the individual and, when applicable, their family members or caregivers. An interview is conducted to gather information about the individual's daily routines, habits, preferences, and any challenges they may be facing.
• Assessment tools and observation: Using standardized tools, the OT assesses physical abilities, cognitive skills, and emotional well-being. Observation of specific tasks at home provides valuable insights.
• Home environment evaluation: The OT assesses the home's physical layout, considering accessibility, safety, lighting, and the need for assistive devices. Specific attention is given to areas where the individual engages in daily activities, such as the kitchen, bathroom, bedroom, and living spaces.
• Collaboration and goal setting: The OT collaborates with the individual and, when appropriate, their family members to set goals based on identified challenges and priorities. Goals are specific, measurable, and tailored to the individual's needs and aspirations.
• Intervention planning: The OT creates a custom plan based on assessment results and goals. This may include assistive devices, therapy exercises, home modifications, and adaptive strategies. They also educate on safety, energy conservation, and daily function improvement.
• Implementation and follow-up: The OT helps implement recommended interventions, including device training, strategy practice, or environmental modifications. Follow-up sessions are scheduled to monitor progress and adjust the intervention plan.
• Collaboration with other professionals: OTs work with other healthcare professionals for a holistic approach to care. They may recommend additional services or support from other agencies.
• Documentation and communication: The OT documents assessment findings and progress in medical records. Communication with individuals and healthcare professionals ensures comprehensive care.

Occupational Therapy Home Assessment example (sample)

Unlock the potential for enhanced well-being and independence by downloading our free Occupational Therapy Home Assessment example. This comprehensive resource provides insight into the structured process of evaluating an individual's abilities within their home environment.

Whether you're a healthcare professional seeking guidance, a caregiver dedicated to supporting a loved one, or an individual looking to optimize daily living, this example offers a valuable glimpse into the world of occupational therapy assessments.

Explore how this tool empowers individuals to overcome challenges, create personalized intervention plans, and foster a home environment that promotes safety and independence for family members. Don't miss the opportunity to access this informative example that can pave the way for improved quality of life. Download now and embark on a more fulfilling and independent lifestyle!

Download this free Occupational Therapy Home Assessment example here 

Interpreting the results of the assessment

Interpreting the results of an occupational therapy home assessment involves thoroughly analyzing the gathered information to understand the individual's strengths, challenges, and areas for improvement. Here's a guide on interpreting the occupational therapist and assessment results:

• Functional abilities: Evaluate the individual's performance in various daily activities, considering their physical, cognitive, and emotional capabilities. Identify areas of strength, independence, and challenges that may hinder their ability to complete specific tasks.
• Home environment: Assess the home environment for safety, accessibility, and potential hazards. Determine if modifications or assistive devices are needed to enhance the individual's independence and reduce the risk of accidents.
• Cognitive function: If applicable, analyze cognitive assessment results, such as those from the Mini-Mental State Examination (MMSE). Identify any cognitive impairments that may impact the individual's ability to manage daily activities and make decisions.
• Mobility and physical skills: Examine the individual's mobility, balance, and fine motor skills. Identify any limitations that may affect their ability to move around the home, perform self-care tasks, or engage in leisure activities.
• Family and caregiver input: Consider feedback from family members or caregivers regarding the individual's daily routines, challenges, and the level of assistance required. Understand the support system available and areas where family involvement can enhance the individual's well-being.
• Goal alignment: Compare the assessment findings with the goals set during the initial meeting. Ensure the identified challenges align with the established goals, allowing for targeted interventions.
• Risk assessment: Evaluate the assessment results for indications of fall risks, safety concerns, or potential barriers within the home environment. Prioritize recommendations that address identified risks to promote a safer living space.
• Intervention recommendations: Develop clear and actionable recommendations based on the assessment findings. Consider assistive devices, home modifications, therapeutic exercises, or strategies to enhance the individual's functional independence.
• Holistic considerations: Take a holistic approach by considering the individual's emotional well-being, social interactions, and overall quality of life. Ensure that recommendations support physical function, mental health, and engagement in meaningful activities.
• Communication and collaboration: Share the assessment results with the individual, involving them in the interpretation process. Collaborate with the individual, family, and other healthcare professionals to refine and implement the intervention plan.

Benefits of Occupational Therapy Home Assessment

Occupational Therapy Home Assessments offer a multitude of benefits by tailoring interventions to an individual's specific needs within their living environment. These assessments enhance safety and independence by identifying and addressing potential hazards, recommending assistive devices, and adapting the home layout.

By focusing on personalized goals, occupational therapists empower individuals to overcome challenges in daily activities, promoting a sense of accomplishment and well-being. The assessments also foster collaboration with family members and caregivers, creating a supportive network.

Improved at-home health and safety, enhanced functional abilities, and targeted interventions contribute to a higher quality of life. Ultimately, Occupational Therapy Home Assessments pave the way for individuals to lead more fulfilling, independent lives, addressing their unique needs and optimizing their engagement in meaningful activities within the comfort and safety of their homes.

Why use Carepatron as your occupational therapy software?

Elevate your occupational therapy practice with Carepatron, a cutting-edge software designed to empower healthcare professionals. Our user-friendly platform revolutionizes documentation, offering seamless note creation and organization for enhanced productivity.

With integrated scheduling, you can track appointments, client progress, treatment plans, and invoicing effortlessly in one central location. Experience the future of telehealth with secure video conferencing, appointment scheduling , and virtual treatment sessions, extending your reach to remote or mobility-challenged patients.

Foster patient engagement through interactive features like telehealth and patient portals. Rest easy with HIPAA compliance managed by Carepatron, ensuring your practice adheres to healthcare regulations.

Save time and streamline payments with our mobile payment tool, allowing automatic charges using your client's preferred method. Enjoy the flexibility of customizable templates and automated documentation, simplifying practice management.

Count on us for exceptional customer support and training resources, ensuring you and your team of clients maximize the software's potential. Join the future of occupational therapy with Carepatron's comprehensive and innovative solutions.

Commonly asked questions

An OT home assessment evaluates a person's ability to perform daily activities at home. It includes assessing the home environment for safety, identifying challenges, and developing personalized interventions.

Home occupational therapy improves daily living activities by modifying the environment and suggesting various assistive technology devices and strategies for independence.

An occupational therapist assesses an individual's physical, cognitive, and emotional abilities through standardized tools, task observation, and personalized goal-setting.

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In-Home Assessment Occupational Therapy Modifications, Checklist, & Interventions

Reasons for home assessment & concerns.

• Functional impairment
• Difficulty with activities of daily living (ADLs), IADLs
• Poor physical health
• Need for assistive devices
• Postsurgical conditions
• Schizophrenia
• Fear of falling((Stark, S., Keglovits, M., Arbesman, M., & Lieberman, D. (2017). Effect of home modification interventions on the participation of community-dwelling adults with health conditions: A systematic review. The American Journal of Occupational Therapy, 71(2), 7102290010p1-7102290010p11.))
• History or risk of falls((Stark SL, Somerville EK, Morris JC. In-Home Occupational Performance Evaluation (I-HOPE). Am J Occup Ther. 2010 Jul-Aug;64(4):580-9. doi: 10.5014/ajot.2010.08065. PMID: 20825129; PMCID: PMC2939744.))

Barriers to Interventions

• Renting compared to ownership of properties
• Availability of professionals, e.g., handymen

Interventions

• Barrier removal resulted in a 36% reduction falls for an intervention group.((Davison, J., Bond, J., Dawson, P., Steen, I. N., & Kenny, R. A. (2005). Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention—A randomised controlled trial. Age and Ageing, 34,162–168. https://doi.org/10.1093/ageing/afi053))
• Balance and strength training
• Low vision: additional lightning
• Hand-held shower heads
• Removal of bathtubs for walk-in showers
• Ramp installation((Stark SL, Somerville EK, Morris JC. In-Home Occupational Performance Evaluation (I-HOPE). Am J Occup Ther. 2010 Jul-Aug;64(4):580-9. doi: 10.5014/ajot.2010.08065. PMID: 20825129; PMCID: PMC2939744.))
• Adaptive equipment, e.g., reacher devices
• Assistive technology, e.g., smart home((Tomita, M. R., Mann, W. C., Stanton, K., Tomita, A. D., & Sundar, V. (2007). Use of currently available smart home technology by frail elders: Process and outcomes. Topics in Geriatric Rehabilitation, 23, 24–34. https://doi.org/10.1097/ 00013614-200701000-00005))((Mann, W. C., Ottenbacher, K. J., Fraas, L., Tomita, M., & Granger, C. V. (1999). Effectiveness of assistive technology and environmental interventions in maintaining independence and reducing home care costs for the frail elderly: A randomized controlled trial. Archives of Family Medicine, 8, 210–217. https://doi.org/10.1001/archfami.8.3.210))
• “Include comprehensive assessment of person and environmental factors that influence occupational performance, including task analysis to identify environmental barriers and supports.”
• “Include training older adults and their caregivers to safely use environmental supports and reestablish habits and routines.”
• “Provide assessment of and recommendations to clients and caregivers, along with adequate training, education, and follow-up for effective home modification interventions to improve participation.”((Stark, S., Keglovits, M., Arbesman, M., & Lieberman, D. (2017). Effect of home modification interventions on the participation of community-dwelling adults with health conditions: A systematic review. The American Journal of Occupational Therapy, 71(2), 7102290010p1-7102290010p11.))

Take-Home Message

“A client-centered intervention plan that includes a mix of exercise, education, home modifications, and assistive technology is supported by the best evidence for fall prevention and occupational performance in community-dwelling older adults.”((Chase, C. A., Mann, K., Wasek, S., & Arbesman, M. (2012). Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults. The American Journal of Occupational Therapy, 66(3), 284-291.))

Home Modification Checklist

• Entrances and exits
• House number visibility
• Bushes and shrubs posing risks
• Working doorbell
• Doors: swinging direction, width and clearance, weight, thresholds
• Floor level changes
• Hallway width
• Floor surfaces
• Clutter reduces
• Covered water pipes
• Controls and faucets accessible
• Drains accessible
• Mirror height adequate
• Shelves and sink basin storage functional
• Transfers in and out of showers and bathtubs (grab bars)
• Toilet height
• Toilet paper accessible
• Flushing accessible
• Toilet transfers safe
• Space for caregivers
• Anti-slip mats
• Task lighting appropriate
• Storage access available, e.g., shelving
• Reachability of items in the refrigerator
• Hot water pipes covered
• Hot-proofed surfaces
• Switches and outlets accessible
• Adequate counter surfaces
• Enough knee clearance at worksites
• Adequate color contrast or tactile controls
• Sturdy step stool
• Clean kitchen area
• Commonly used items and foods most accessible

Living Spaces

• Wide enough pathways
• Secured throw rugs
• Access space between furniture
• Rails or armrests available for transfers
• Functional storage and closet
• Adequate lighting
• Furniture at an appropriate height
• Clearance between furniture
• Level floor surfaces

Storage Spaces

• Lights installed
• Adjustable rods and shelves available
• Enough space and clearance to access closet
• Handles and locks are accessible
• Blinds and blackout curtains for sleep and reduction of glare
• Worksite available for sorting and folding clothes
• Clothesline at a convenient height
• Washer and dryer at a convenient height and location
• Controls for appliances accessible
• Well-lit areas
• Combustible materials and hazardous waste requiring removal
• Pathway clear to access utilities
• Fall hazards reduced

Safety and Comfort

• Heating and cooling thermostat controls are accessible
• Presence of functioning smoke and CO alarms
• Fire extinguishers accessible
• Water heater adjusted to safe temperature to reduce burns (120 degrees F)
• Scalding water safety shut-off valves at water fixtures
• General lighting is adequate and available where needed
• Exits available and clear for emergencies

Funding and Resources

• Some local governments may provide grants to install home modifications if justified.

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Home Quick – Occupational Therapy Home Visits Using mHealth, to Facilitate Discharge from Acute Admission Back to the Community

Jacqueline nix.

1 OCCUPATIONAL THERAPY DEPARTMENT, REDCLIFFE HOSPITAL, METRO NORTH HOSPITAL AND HEALTH SERVICE DISTRICT, ANZAC AVE, REDCLIFFE, 4020, AUSTRALIA

TRACY COMANS

2 METRO NORTH HOSPITAL AND HEALTH SERVICE, BUTTERFIELD ST, HERSTON, 4006, AUSTRALIA

3 MENZIES HEALTH INSTITUTE QUEENSLAND, GRIFFITH UNIVERSITY, NATHAN, 4111, AUSTRALIA

This article reports upon an initiative to improve the timeliness of occupational therapy home visits for discharge planning by implementing technology solutions while maintaining patient safety. A community hospital in Queensland, Australia, hosted a process evaluation that examined which aspects of home visiting could be replaced or augmented by alternative technologies. Strategies were trialled, implemented and assessed using the number of home visits completed and the time from referral to completion as outcomes. A technology-enhanced solution called “Home Quick” was developed using technology to facilitate pre-discharge home visits. The implementation of Home Quick resulted in an increase in the number of home visits conducted prior to discharge (50% increase from 145 to 223) and significantly increased the number of patients seen earlier following referral ( X 2 =69.3; p<0.001). The substitution of direct home visits with technology-enabled remote visits is suitable for a variety of home visiting scenarios traditionally performed by occupational therapists.

Occupational therapists (OTs) are often required to assess a patient’s home for safety before discharge as part of their role in acute care and rehabilitation teams ( American Geriatrics Society/British Geriatric Society, 2011 ; Cumming et al., 2001 ; Cumming et al., 1999 ). These typically take the form of an OT and an OT assistant attending the patient’s home, usually with family in attendance, to assess the person-environment fit, and ensure a safe discharge. These home visits have been shown to minimise the risk of falls and other adverse events ( Cumming et al., 1999 ; Di Monaco et al., 2008 ; Peterson & Clemson, 2008 ; Pighills, Torgerson, Sheldon, Drummond, & Bland, 2011 ). A complex home assessment with a patient including driving and administrative tasks can take over five hours.

When the OT is unable to visit the home in a timely manner and the patient is considered medically stable and ready for discharge, a subsequent delay to discharge occurs that is commonly termed “bed blocking” ( McBride, 1995 ). The problem is further magnified when the time spent conducting a home visit delays the treatment of other inpatients under the care of the OT. This can result in precipitous discharges that increase the risk of early readmission ( Dobrzanska & Newell, 2006 ). It is well recognised that patients recuperating in acute facilities under current health system constraints is not a viable practice. Demand simply outweighs capacity ( Travers et al., 2008 ). Therefore, it is important that prompt home visits can be performed in order to facilitate the safe and timely discharge of appropriate patients.

The World Federation of Occupational Therapists has published a position statement on the use of telehealth to improve accessibility to occupational therapy ( World Federation of Occupational Therapists, 2014 ). Telehealth is considered appropriate when in-person services are not feasible or optimal for delivering care, and/or both provider and client are happy with provision by telehealth. Telehealth has been suggested as an effective and reliable way to access home modification services ( Cason, 2014 ; Sanford, Jones, Daviou, Grogg, & Butterfield, 2004 ). The rapidly expanding opportunities and funding for telehealth provision are creating a space for occupational therapists to deliver services including home assessments and modification recommendations in new ways ( Cason, 2012 ).

Published use of technology for home visits is limited and has mainly been focussed on rehabilitation. One study used photography to identify potential hazards remotely, and follow up with a conventional home visit if indicated ( Daniel et al., 2013 ). A comparative trial of pre-admission visits for patients undergoing joint replacements found that there was high agreement between in-home and remote OT assessments with consistency in 90% of the identified home environment hazards and height measurements only varying between 0.1–3.3 cm ( Hoffmann & Russell, 2008 ). This study used a conventional internet connection with videoconferencing facilities. However, these conventional telehealth systems are not necessarily suitable for the requirements of acute wards as they require pre-booking and specialist technical knowledge to operate. Mobile technology offers an alternative that is relatively cost-effective and easily accessible to both patients and OTs.

BACKGROUND TO THE ‘HOME QUICK’ PROJECT

The Metro North Hospital and Health Service (MNHHS) covers a population of approximately 900,000 in the southern part of Queensland, Australia. The district contains five public hospitals, two tertiary hospitals located in the capital Brisbane, two community hospitals covering outer metropolitan areas and one small rural hospital. This project was located in the catchment of the community and rural hospitals and was based in Redcliffe. The area has a high elderly population and low socio-economic status with the highest concentration of older lone person households in Australia according to census data ( Australian Bureau of Statistics, 2004 ).

There were a number of issues that arose to subsequently drive the need to investigate the use of technology to improve home visiting services:

• The OTs at the community and rural hospitals covered 80% of the geographic area of MNHHS (4157 km 2 ).
• The large area resulted in frequent 1–2 hour (one way) trips by car to the patient’s home. The combination of requirements to conduct the home assessment, administrative tasks and report writing means a home visit could take over half the working day.
• The community and rural hospitals have a small workforce to patient ratio in the acute wards (community hospital one has 120+ beds with 3.0 Full Time Equivalent (FTE) OT staff; community hospital two has 70+ beds with 2.0 FTE; and rural hospital has 10 beds with 0.2 FTE)
• There was a loss of public federally funded community health OTs in 2010–11 due to the restructuring of services by the state government, with OT services not fully replaced.
• Risk assessments could stop a home visit from being conducted. For example: floods; bad weather; distance; dangerous animals on premises; not able to take another staff member; patient at risk of absconding.
• Car availability, family availability, distance to travel, time to organise equipment or rails if required, and competing demands on wards limited the ability of OTs to rapidly perform home assessments required for discharge.

At the same time, personal technologies such as smart phones were becoming ubiquitous and communication applications (apps) were readily available that had the potential for use in home visiting scenarios. In addition, routinely collected data systems in MNHHS were accessible for the purposes of evaluation. For example, being able to scan activity in real time with meaningful units linked to the Health Round Table Data, a database which is used to compare peer facilities to examine efficiency and identify gaps in services to be investigated ( The Health Roundtable, 2015 ). The aim of this project was to improve the timeliness of home visits by implementing and using technology-based solutions while maintaining patient safety.

MATERIALS AND METHODS

This study used the “Plan, Do, Study, Act” (PDSA) framework for the implementation and evaluation of this project. PDSA is a widely accepted method in health care for quality improvement activities allowing small scale experimentation before implementing more broadly ( Taylor et al., 2014 ). In brief, the components used in this study were:

• Plan: conduct literature review; conduct survey of patients and staff; compare different phones and laptops; understand legal and ethical implications.
• Do: create new model and trial with orthopaedic patients.
• Study: evaluate the process and change resources where needed.
• Act: implement for a trial period.?

LITERATURE SURVEY

A review of the literature was undertaken by searching PubMed, CINAHL and the Clinician’s Knowledge Network with the key words: home visit, occupational therapy, assessment and technology. A small number of articles were found discussing the use of telehealth in occupational therapy (summarised earlier) and no relevant articles were found that had used mobile technology for home visiting or were able to inform the proposed model of care.

SCOPING SURVEY

An initial survey of older patients was carried out to determine whether the target population had access to smart phones and relevant video calling apps such as Skype. Included participants were patients from inpatient medical and surgical wards aged over 70 years who were able to provide informed consent. Patients were excluded if they had previously experienced a stroke or were currently experiencing other cognitive issues such as dementia or delirium. For people with non-English speaking backgrounds, an interpreter was used where required.

MODELS OF CARE

A process evaluation of home visiting tasks was undertaken with the OT departmental staff at Redcliffe hospital to identify tasks that: (a) should not change; (b) could not change; and (c) should and could change with the addition of technology. Following this, a focus group session was conducted with 15 staff members (12 OTs, 2 OT assistants, 1 line manager). The purpose of this session was to problem solve a range of viable options (both technology-driven and usual care) to include in the implementation trial with patients awaiting discharge from hospital and develop a risk screening tool that could identify issues with home visiting that may preclude particular types of options for certain patients.

During home visits undertaken by OT staff, measurements are routinely taken within the home of key distances such as the width of doorframes, the height of steps, and the height of toilets. In order to facilitate the trial of technology-assisted home visits, a booklet was designed for patients, families, carers and new staff members to instruct them on the correct way to take these measurements. The success of the instruction booklet was evaluated by comparing measurements taken on the same properties by: (a) OT staff; and (b) a convenience sample of patients awaiting hip and knee replacement surgery who were members of a consumer advocacy group.

IMPLEMENTATION TRIAL

The process was initially piloted on pre-operative orthopaedic patients awaiting joint replacement surgery, with the exclusion of patients from residential care facilities. Following the pilot, the process was expanded to include any patient requiring home assessment to ensure safe discharge, prevent complications and /or readmission. The range of options (“Home Quick”) was trialled from September to December 2013, and implemented for all suitable patients from February 2014.

DATA ANALYSIS

A pre-post analysis was conducted of the intervention to understand the changes in throughput and efficiency gained from the introduction of the use of technology. Data on the days taken to complete home assessments from referral, increases in ward activity by OT and increases in home assessments was collated using routinely collected administrative data from electronic data systems.

Data was collected in two six month periods; pre-intervention was collected Feb to Aug 2013 and post intervention Feb to Aug 2014. The same months of the year were chosen so that seasonal variations in home visit requests and other acute ward demands would be similar and thus accounted for. The intervening 6 months allowed the new service delivery model to be piloted and subsequently embedded into practice.

As the process was implemented as a quality improvement activity of an existing service, human research ethics approval was not required.

Thirty patients awaiting orthopaedic surgery were recruited from either the orthopaedic ward or medical ward and gave consent to participate in the survey. Twenty-seven (90%) patients owned a smart phone, and of these patients, 20 (75%) were aware of Skype or video phone calling and 13 (50%) had used Skype on a computer (with and without help). Of the people who did not have a smart phone (n = 3, 10%), all of them had a next of kin who had a smart phone. Only 4 (13%) of the 30 patients felt uncomfortable with the idea of a video call showing the inside of their home.

The standard home visit procedure used a pen, paper, tape measure and standard digital camera. An area for improvement would be that photographs and drawings of the room would be made where the equipment (e.g., grab rail) should be placed. Following the visit, details of the home visit would need to be typed into a report with drawings and photographs imported. This would be printed and filed in the patient’s chart.

The results of the process evaluation are reported in Table 1 . The OT department staff nominated a number of processes within standard care that could be changed or improved with technological solutions (e.g., the use of multiple paper forms used for recordkeeping during home assessments that required manual entry into a computer upon returning to the office). There were also aspects that could not be changed (e.g., the distance to a home assessment) that could potentially be mitigated with the use of a technology substitute to a traditional home visit.

Process Review Outcomes

During the focus group session, participants were enthusiastic about finding ways to eliminate duplication and be more administratively efficient using technology. The critical issue was removing the need for the OT to leave the hospital. Allied Health Assistants (AHAs) were already undertaking ‘access visits’ to photograph and measure appropriate areas of the house. The OT would then review this information on the AHA’s return to the hospital. To optimise this process, real time video footage would be ideal to allow the OT to view the different areas of the home in more detail, whilst still having a staff member on site to ask specific questions of the patient and their carers/family, for example, the slipperiness of the floors.

The first solution produced by the focus group session was an innovative mobile health (mHealth) process to enable the OT to talk to an AHA, junior OT (i.e., a new graduate, up to about five years post-graduation), or the carer/ family member at the house, and even pre-op patients using smart phones and readily available apps. The Hospital Management Committee approved the upgrade of staff mobile phones to a smart phone with a data plan in order to facilitate the implementation of this solution.

A second solution to save time in completing home visits involved moving from the standard home visit procedure with pen and paper record keeping to a laptop or tablet device for electronic record keeping. The device needed: (a) a USB port; (b) to be Microsoft Word® compatible; (c) to perform multiple functions such as still photography and video filming; and (d) to allow the OT to finalise the report at the patient’s home or during the drive back to the hospital. This process removed the duplication present in the standard home visit of re-entering data into a computer once back at the hospital.

The combination of options for technology enabled or enhanced visits constitutes the ‘Home Quick’ intervention (see Table 2 ). Some of the ‘Home Quick’ options were traditional visits augmented by technology whilst others were new mHealth options. These options recognise the need for some assessments that require an OT to attend the home of the patient, whilst promoting the option that many conventional visits could be replaced or improved with the use of technology.

Home Quick Options

Note . AHA = Allied Health Assistant; OT=Occupational Therapist.

The risk screening tool developed during the pilot implementation phase is described in Figure 1 . Firstly, patients were assessed to determine if they would benefit from a functional home visit during which an OT would check the safety of the patient to navigate his/her home. If the patient required such a visit, the second step was to identify if the patient was medically safe to attend a home visit whilst still an inpatient. Thirdly, if the home environment was assessed as safe, an OT would then attend the home visit with the patient. If the patient was not medically safe enough to attend the home visit, an alternative access visit, either the traditional option with an OT or AHA visiting the home, or the technological mHealth option could be used.

The risk screening tool developed during the pilot implementation phase.

The instruction booklet formed to educate patients, families, carers and new staff on the correct method of measuring a property was found to be useful and informative enough for family or assistants to take measurements. Only one out of the ten homes assessed was measured incorrectly in one area. As a result, revisions were made to target door jamb measurements and no further errors were found in a further six assessments.

Table 3 presents the number of occupational therapy interventions conducted during both trial time periods. After the introduction of Home Quick, OTs were able to undertake 78 more home visits (145 vs 223), an increase of more than fifty percent. In addition, the number of other inpatient interventions (assessments and treatments) also increased (range, +16 to +115%). Overall, total interventions increased by 31% over the equivalent six months from the year before with the same level of staffing (3.0 FTE) in place. Staff were able to give patients on average an additional one occasion of service post introduction of the new service model.

Number of Occupational Therapy Interventions on Acute Inpatient Wards

Table 4 presents the percentage of home visits completed within specific time frames from the time of referral. Significantly more patients had referrals completed earlier following referral after the implementation of mHealth ( X 2 =69.3; p<0.001). In particular, the number of patients seen on the same day or within one day of referral increased from 20% to 60%.

Time Taken to Complete the Home Visit from Time of Referral

This project has demonstrated that simple on-site home visits can safely be performed or augmented using technology, and that this service delivery model improves the throughput and efficiency of hospital-based OT departments without changing staffing levels. Home Quick reduced the time and administrative burden required to perform routine home visits. As a result, OT departments were able to improve their service capacity in other sectors of care. The implementation of the Home Quick intervention resulted in shorter wait times between referral and completion of home visits and an increase in the overall capacity of the OT workforce to undertake both home and other important assessments required in the acute sector. Home Quick has now been embedded into practice and is part of the standard home visiting options available within MNHHS.

Technology has the ability to substantially change how health care is provided. For the MNHHS in particular, there are specific advantages to being able to conduct home assessments remotely. Patients within the MNHHS are admitted from all over the state to tertiary hospitals in Brisbane to access specialised services. In these cases, the patient’s home may be over 1,000 km away from their tertiary facility and physical home visits are not possible. Other benefits include being able to complete a home visit in situations that would otherwise not permit a home visit. Such situations include where an environmental risk has been identified, such as a dangerous dog or difficult family situation. Technology is changing rapidly; smart phones and apps that allow video streaming are becoming more easily accessible, allowing this type of home visiting to become routine practice for OTs within MNHHS.

There were many challenges that had to be overcome in order to implement Home Quick successfully. Many of these involved legislative requirements and existing IT systems. Legislative issues arose around the inability to send data from home visits via email or to store it on cloud servers as these servers were outside the organisation and therefore did not comply with privacy regulations. Video calls could not be recorded live. This was overcome by the use of tablets that could store the data until it could be downloaded at the hospital. Policy around use of technology within health care organisations can be a barrier to its implementation, delaying the use of such devices and limiting efficiency. Internet access proved to be another challenge: there was limited Wi-Fi and internet coverage within the hospital, and some patients had limited data on their mobile plans, increasing the cost of their participation. Finally, not all OTs were comfortable with the use of technology to facilitate home visits, perceiving the change as a challenge or a diminishing of the role of the OT.

The quantitative improvements in this project may not all be attributable to Home Quick. In the health service district at the time, there was a focus from the health service on improving patient flow and discharge patients home safely and quickly. A concurrent project was the use of a discharge planning co-ordinator to facilitate earlier discharge. Consequently, we are unable to separate definitively the improvements resulting from Home Quick from these other efficiency initiatives. However, the mHealth options developed in this project are a considerably faster way of conducting a home visit compared to the traditional physical home visit. Furthermore, our practising clinicians perceive value in this service, demonstrated by the way staff have now embedded Home Quick into standard practice at the hospitals within our service district.

Through the use of the “Plan, Do, Act, Study” framework, a technology-assisted service delivery model (Home Quick) for home visits by occupational therapists was successfully implemented in three community and rural hospitals. This led to an overall increase in the productivity of OT staff, as well as improved timeliness of OT assessment for suitable patients. This can serve as a model for other OT departments to consider the use of technology to improve productivity in their departments, with appropriate consultation with their health care organisation to ensure flexibility and sustainable uptake of a technology used widely by the general community.

ACKNOWLEDGEMENTS

The authors would like to acknowledge the support of Allied Health Director-Gayle Sutherland, the Executive Team and the Occupational Therapy Department at Redcliffe Hospital without whom this idea would not have been translated into clinical practice. The authors would also like to thank Amy McKenzie and Elise Gane for their assistance in editing the final manuscript.

DISCLOSURE STATEMENT

No competing financial interests exist for either of the authors.

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OT Notes (SOAP Examples and Cheat Sheets!)

• Post date --> April 17, 2023
• Sticky post

Improve your occupational therapy documentation.

See a Sample Documentation Example ! Plus, check out other Club features with this 5-day trial.

Our occupational therapy notes help us track patient progress, communicate with other healthcare providers, and defend our rationale for our treatment choices. 

But, as we all know, documentation can take FOREVER—and we might not have as much time as we’d like to do it justice.

We are constantly grappling between wanting to write the perfect OT note—one that succinctly says what we did and why we did it—and finishing our documentation as quickly as possible.

Here you’ll find resources to simply the process.

In this guide, you’ll find: 

• OT Potential’s list of documentation examples (paid membership)
• DO’s and DON’Ts of OT documentation (free)
• OT documentation cheat sheets
• A sample OT evaluation (free)

OT Documentation Examples in the OT Potential Club

In the OT Potential Club , our OT evidence-based practice platform, you can also access our library of documentation examples. 

These are real-life documentation examples. Every setting and facility is different, so they are not intended to be copied for your own use. Rather, they are designed to be discussion-starters that help us improve our documentation skills. 

Here’s the examples we have so far:

Acute Care—Adults & Pediatric

• Acute Care OT Eval (s/p THA) 
• Acute Care OT Tx Note (s/p THA)
• Acute Pediatric OT Eval (diagnosis: acute myeloid leukemia)
• Acute Pediatric Tx Note (diagnosis: acute myeloid leukemia)
• Inpatient Rehabilitation Eval (diagnosis: ischemic stroke)

Assisted Living Facilities (ALF)

• ALF OT Eval (s/p fall)
• ALF Treatment Note (s/p fall)

Early Intervention (EI)

• EI Eval (diagnosis: Down’s Syndrome)
• EI Tx Note (diagnosis: Down’s Syndrome)
• Telehealth EI Development Eval

Home Health

• Home Health OT Eval (s/p femur fx)

Outpatient (OP)—Adults & Pediatric

• Low Vision Treatment Note 
• Home modification eval and treatment note: Medicare covered
• Home modification eval: Private Pay
• Home-visit Treatment Note (Showcasing caregiver support)
• OP Eval (diagnosis: POTS)
• OP OT Eval (diagnosis: carpal tunnel release)
• OP OT Eval (s/p concussion)
• OP Pediatric Eval (diagnosis: autism, ADHD)
• OP Pediatric OT Eval (diagnosis: autism)
• OP Tx Note (diagnosis: Multiple Sclerosis, participatory medicine tx approach)
• OT Treatment Note (s/p concussion)
• OP Pediatric Treatment Note (Neurodiverstiy-affirming supports for an ADHDer child) 
• OP Tx Note (diagnosis: post-stroke, self-management tx approach)
• Outpatient Med B eval (featuring assistive tech)
• Outpatient Med B daily note (featuring assistive tech)
• Outpatient OT Eval (diagnosis: breast cancer)
• Outpatient OT Tx Note (diagnosis: breast cancer)
• OT Eval (Outpatient Dementia Care) 
• OT Tx Note (Outpatient Dementia Care)
• Power Wheelchair Evaluation
• Power Wheelchair Treatment Note
• Pediatric Telehealth Eval—Private Pay
• Pediatric Telehealth Tx Note—Private Pay

Mental Health

• OT Inpatient Psych Eval (adolescent with suicidal ideation)
• OT Inpatient Psych Treatment Notes (adolescent with suicidal ideation)

School-based OT

• School-based OT Eval Report: (diagnosis: autism)
• School OT Eval (diagnosis: Down’s Syndrome)
• Telehealth School OT Eval Example (diagnosis: trisomy 21)
• Telehealth School OT Tx Note (diagnosis: trisomy 21)

Skilled Nursing Facility (SNF)

• SNF OT Eval (s/p THA)
• SNF OT Tx Note (s/p THA)

DO’s and DON’Ts of Writing Occupational Therapy Documentation

We know documentation varies widely from setting to setting, so we are using the universal SOAP (Subjective, Objective, Assessment, Plan) note structure to break down our advice. 

Even if you don’t use this exact structure in your notes, your documentation probably has all of these dimensions.

Subjective (S)

Do use the subjective part of the note to open your story.

Each note should tell a story about your patient, with the subjective portion setting the stage.

Try to open your note with feedback from the patient on what is and isn’t working about their therapy sessions and home exercise program. For example, you can say any of the following to get your note started:

• “Patient states she was excited about ____.”
• “Patient reports he is frustrated he still can’t do ____.”
• “Patient had a setback this past weekend because ____.”

In sentence one, you’ve already begun to justify why you’re there! If you need some good questions to draw out this kind of feedback from patients, check out Good Questions for OTs to Ask . 

DON’T go overboard with unnecessary details

Let’s admit it: we are storytellers, and we like to add details. But, we’ve all seen notes with way too much unnecessary information. Here are a few things you can generally leave out of your notes:

• “Patient was seated in chair on arrival.”
• “Patient let me into her home.”
• “Patient requested that nursing clean his room.”

Details are great, because they help preserve the humanity of our patients. But, it’s really not necessary to waste your precious time typing out statements like these.

Channel your inner English major. If a detail does not contribute to the story you are telling—or, in OT terms, contribute to improving a patient’s function—you probably don’t need to include it 🙂

Objective (O)

Do go into detail about your observations and interventions.

The objective section of your evaluation and/or SOAP note is often the longest.

This section should contain objective measurements, observations, and test results. Here are a few examples of what you should include:

• Manual muscle tests (MMTs)
• Range of motion measurements (AAROM, AROM, PROM, etc.)
• Level of independence (CGA, MIN A, etc.)
• Functional reporting measures (DASH screen, etc.)
• Objective measures from assessments related to the diagnosis

For a comprehensive list of objective measurements that you can include in this section, check out our blog post on OT assessments . We compiled over 100 assessments you can use to gather the most helpful data possible.

Assessment (A)

Do show clinical reasoning and expertise.

The assessment section of your OT note is what justifies your involvement in this patient’s care.

Here, you’ll synthesize how the patient’s story aligns with the objective measurements you took (and overall observations you made) during this particular treatment session.

Your assessment should answer these questions:

• How does all of this information fit together?
• Where (in your professional opinion) should the patient go from here?
• Where does OT fit into the picture for the patient’s treatment plan?

DON’T skimp on the assessment section

The assessment section is your place to shine! All of your education and experience should drive this one crucial paragraph.

We tend to simply write: “Patient tolerated therapy well.” Or we copy and paste a generic sentence like: “Patient continues to require verbal cues and will benefit from continued therapy.”

Lack of pizazz aside, that’s not enough to represent the scope of your education and expertise—nor the degree of high-level thinking required to carry out your treatments.

Instead, consider something like: “Patient’s reported improvements in tolerance to toileting activities demonstrate effectiveness of energy conservation techniques she has learned during OT sessions. Improved range of motion and stability of her right arm confirms that her use of shoulder home exercise plan is improving her ability to use her right upper extremity to gain independence with self care.”

DON’T get lazy

I once took a CEU course on note-writing that was geared toward PTs.

It felt like most of the hour was spent talking about how important it is to make goals functional. But we OTs already know this; function is our bread and butter.

So, why do many OTs insist on writing things like: “Continue plan of care as tolerated”?

Not only do utilization reviewers hate that type of generic language, but it also robs us of the ability to demonstrate our clinical reasoning and treatment rationale!

DO show proper strategic planning of each patient’s care

This section isn’t rocket science. You don’t have to write a novel. But, you do need to show that you’re thinking ahead and considering how care plans will change as patients progress through treatment.

Consider something like this: “Continue working with patient on toileting while gradually decreasing verbal and tactile cues, which will enable patient to become more confident and independent. Add stability exercises to home exercise program to stabilize patient’s right upper extremity in the new range. Decrease OT frequency from 3x/week to 2x/week as tolerated.”

Short, sweet, and meaningful.

General DO’s and DON’TS for documentation

In every good story, there’s a hero and a guide. In the case of OT notes, your patient is the hero—and you are the guide. To take that metaphor one step further: If the patient is Luke Skywalker, you are Yoda.

I think as therapists, we tend to document only one part of the story.

Some of us focus on the hero’s role: “Patient did such and such.”

Others focus on what we, the guide, accomplish with our skilled interventions: “Therapist downgraded, corrected, provided verbal cues.”

But, a really good note—dare I say, a p erfect note—shows how the two interact.

If your patient tells you in the subjective section that they are not progressing as quickly as they would like, what did you, as the therapist, do to upgrade their intervention? Your notes should make it apparent that you and the patient are working together as a team.

Let’s look at a few examples:

• “Patient reported illness over the weekend; thus, activities and exercises were downgraded today. Plan to increase intensity when patient feels fully recovered.”
• “Patient has made good progress toward goals and is eager for more home exercises. Plan to add additional stability work at next visit.”

DO be very careful with abbreviations

While I was creating this blog post, I read every piece of advice I could find on documentation—and I had to chuckle, because there was simply no consensus on abbreviations.

Abbreviations are obviously great for saving time—but they can make our notes cryptic (read: useless) to those outside of our specialty.

In an ideal world, we type the abbreviation and our smartie computer fills in the full word or phrase for us. And, for those of us who use an EMR on Google Chrome, this is exactly what can happen. WebPT, for example, allows this integration.

If you don’t already use keyboard shortcuts, contact your IT department and see if there are any options within your EMR. If you aren’t able to implement these shortcuts, I highly recommend that you request them!

I’ve got an article about OT documentation hacks that delves more into the topics of text expanders and abbreviations!

Okay, after all of that, I bet you’re ready to see an OT evaluation in action. You’re in luck, because I have an example for you below!

OT Documentation Cheat Sheets

One of the first things I did in any new setting was make myself a documentation template/cheat sheet. 

During my orientation, I would ask a fellow OT if I could see an example of the notes they were writing. Then I would use their example as I crafted my first notes. When I made a note I was happy with, I would print a copy and keep it on my clipboard. 

I think the key here is to make the cheat sheet that is right for you. You may simply want a list of power words to use in your notes. Or, you may want a full-fledged note. It may be electronic or something you print and keep at your desk. 

In one setting, I created an eval checklist, made copies of it, and used it to take notes so I always had all of the info handy. 

At the end of the day, each setting—and therapist—is different. So, take the time to make the cheat sheet that will be most useful to you. 

Here are some examples to get you started:

• The Note Ninjas Cheat Sheet (contains do’s and don’ts for skilled care)
• PT Progress Templates (paid resource)
• Printable Cheat Sheet
• Pediatric Goal Bank

Example Outpatient Occupational Therapy Evaluation

Okay, we’re getting to the good stuff—full OT note examples. 

Below is an example outpatient hand therapy note. I chose to feature this type of note because they tend to be on the longer side, thus allowing me to showcase multiple aspects of note writing.

Name: Phillip Peppercorn

MRN : 555556

DOB: 05/07/1976                              

Evaluation date: 12/10/18

Diagnoses: G56.01, M19.041

Treatment diagnoses: M62.81, R27, M79.641

Referring physician: Dr. Balsamic                   

Payer: Anthem

Visits used this year: 0                         

Frequency: 1x/week

Patient is a right-handed male software engineer who states he had a severe increase in pain and tingling in his right hand, which led to right carpal tunnel release surgery on 11/30/18. He presents to OT with complaints of pain and residual stiffness while performing typing movements, stating, “I’m supposed to go back to work in three weeks, and I don’t know how I will be able to function with this pain.”

Post surgery, patient complains of 2/10 pain at rest and 7/10 shooting pain at palmar region extending to second and third digits of right hand when working at his computer for extended periods of time and when doing basic household chores that involve carrying heavy objects (like laundry and groceries). The numbness and tingling he was feeling prior to surgery has resolved dramatically.

Past medical/surgical history: anemia, diabetes, right open carpal tunnel release surgery on 11/30/18

Hand dominance: right dominant

IADLs: independent, reports difficulty typing on phone and laptop, and with opening and closing his laptop computer since surgery

ADLs: opening drawers at work, opening door handles at office building

Living environment: lives alone in single-level apartment

Prior level of functioning: independent in work duties, activities of daily living, and instrumental activities of daily living.

Occupational function: works a job as a software engineer; begins light-duty work with no typing on 12/20, MD cleared for 4 initial weeks

Range of motion and strength:

Left upper extremity: Range of motion within functional limits at all joints and on all planes.

Right upper extremity: Right shoulder, elbow, forearm, digit range of motion all within normal limits on all planes.

Right wrist:

Flexion/extension—Strength: 4/5, AROM: 50/50, PROM: 60/60

Radial/ulnar deviation—Strength: 4/5, AROM: WNL, PROM: NT    

Standardized assessments:

Dynamometer

Left hand: 65/60/70

Right hand: 45/40/40

Boston Carpal Tunnel Outcomes Questionnaire (BCTOQ)

Symptom Score = 2.7

Functional Score = 2.4

Sutures were removed and wound is healing well with some edema, surgical glue, and scabbing remaining.

Patient was provided education regarding ergonomic setup at work and home, along with home exercise program, including active digital flexor tendon gliding, wrist flexion and extension active range of motion, active thumb opposition, active isolated flexor pollicis longus glide, and passive wrist extension for completion 4-6x/day each day at 5-10 repetitions.

He was able to verbally repeat the home exercise program and demonstrate for therapist, and was given handout.

Patient was given verbal and written instruction in scar management techniques and scar mobilization massage (3x/day for 3-5 minutes). He was also issued a scar pad to be worn overnight, along with a tubular compression sleeve.

Mr. Peppercorn is a 46-year-old male who presents with decreased right grip strength and range of motion, as well as persistent pain, following carpal tunnel release surgery. These deficits have a negative impact on his ability to write, type, and open his laptop and door handles. Anticipate patient may progress more slowly due to diabetes in initial weeks, but BCTOQ reflects that the patient is not progressing as quickly as normal, and is at risk of falling into projected 10-30% of patients who do not have positive outcomes following carpal tunnel release. Patient will benefit from skilled OT to address these deficits, adhere to post-op treatment protocol, and return to work on light duty for initial four weeks.

Plan of care

Recommend skilled OT services 1x/week consisting of therapeutic exercises, therapeutic activities, ultrasound, phonophoresis, e-stim, hot/cold therapy, and manual techniques. Services will address deficits in the areas of grip strength and range of motion, as well as right hand pain. Plan of care will address patient’s difficulty with writing, typing, and opening and closing his laptop and door handles.

Short Term Goals (2 weeks)

• Patient will increase dynamometer score in bilateral hands to 75 lb in order to do laundry.
• Patient will increase right digit strength to 3+/5 in order to open door handles without using left hand for support.

Long Term Goals (6 weeks)

• Patient will increase right wrist strength to 5/5 to carry groceries into his apartment.
• Patent will increase active range of motion in wrist to within normal limits in order to open and close his laptop and use door handles without increased pain.
• Patient will increase dynamometer score in bilateral hands to 90 lb in order to return to recreational activities.  
• Patient’s Boston Carpal Tunnel Outcomes Questionnaire score will decrease to less than 1.7 on symptoms and function to return to work and social activities without restrictions.

O. Therapist, OTR/L

97165 – occupational therapy evaluation – 1 unit

97530 – therapeutic activities – 1 unit (15 min)

97110 – therapeutic exercises – 2 unit (30 min)

Documentation can get a bad rap, but I believe OT practitioners are uniquely poised to write notes that are meaningful to other healthcare practitioners and patients alike.

It seems inevitable that our patients will gain easier access to their notes over the next decade, and when they do, I want our documentation to stand out as relevant and useful.

More resources for improving your documentation

I recognize that defensible documentation is an ever-evolving art and science, and I have come across several useful resources that will help you keep your notes complete, yet concise. I highly recommend the following:

• The Seniors Flourish Podcast: Simplify Your Documentation (five-part series)
• WebPT: Defensible Documentation Toolkit (download required)
• The Note Ninjas website

Special Thanks

Thank you to The Note Ninjas , Brittany Ferri (an OT clinical reviewer), and Hoangyen Tran (a CHT) for helping me create this resource!

12 replies on “OT Notes (SOAP Examples and Cheat Sheets!)”

That note above would take me 30min to produce. Who is paying for my time? Am I working for free, or am I actually stealing from the patient’s time?

Hi Chris! You are right. We have a serious problem with the expectations around defensible documentation and the lack of time/reimbursement for them! I think it is important that as therapists we do our best to share what our ideal notes would look like, so that the structure isnt always dictated to us by other parties and so hopefully technology will one day make the process easier instead of more cumbersome!

Hey Sarah, this info is so helpful as it pertains to older adults. Just a clarifying question – when you stated, "a perfect note—shows how the two interact" and continued to provide the two examples below that would you normally include those under the Plan (P) section of the soap note?

Ohh great question! I see what you are talking about. For treatment notes, many therapists actually combine their assessment and plan sections, which is where you would find sentences like the ones I listed. Every setting is unique though, so definitely structure the note in away that works for your particular situation!

I often see goals in the Assessment portion (rather than plan) because the therapist is assessing based on findings in the O-section as to what the believed outcomes might be. Thoughts?

I’m glad you pointed this out! There is a lot of variation in how people use the SOAP note structure. I agree that putting goals in the assessments is a common variation. Another common variation is what is included in the subjective section….sometimes patient history is there, and sometimes it is in the objective section.

I think the best approach is always to find out what your particular setting prefers.

Hi Sarah, Thanks for this information and the example that you provided. Could you give some example of UK SOAP notes? Am in the UK.

Excellent blog. I really like what you have acquired here, I really like what you’re stating and the way in which you say it. I can’t wait to read much more from you.

I think examples of treatment note continuity (3, or more consecutive treatment notes) would be very helpful for illustrating therapy flow.

I think that would be very helpful too!

I am thinking about the occupational profile and how AOTA is advocating for its use in all evaluations. I am wondering what your thoughts are on including the actual template in evaluations. I see your sample above did not do this despite that being the current recommendation to do so.

Hi. Can I check whether goals e.g. short-term & long-term goals, should be under Assessment or Plan? I get confused about it. Based on Subjective & Objective, I will interpret my findings & formulate my goals under Assessment, & then select a particular intervention related to the short-term goal under Plan for the next session. I understand that some people place them under Plan too.

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Occupational Therapy Home Assessment

Plan the visit and study the patient's case file, travel to the patient's home, introduce the purpose of the visit, conduct initial interview with patient and caregivers, observe the patient's behavior and interaction with others, assess home environment, including entrances, stairs, and bathrooms.

• 1 Entrances
• 3 Bathrooms
• 4 Living Area

Review the use of home appliances and utilities in detail

• 1 Kitchen Appliances
• 2 Heating/Cooling Systems
• 3 Assistive Technology
• 5 Security Systems

Assess the need for home modifications or additional equipment

• 1 Ramp for wheelchair access
• 2 Grab bars in bathroom
• 3 Raised toilet seat
• 4 Stairlift
• 5 Wheelchair

Make note of potential safety risks and hazards

• 1 Loose rugs or carpets
• 2 Sharp edges or corners
• 3 Uneven surfaces
• 4 Poor lighting
• 5 Cluttered pathways

Evaluate the patient's ability to perform activities of daily living

• 1 Personal hygiene
• 5 Toileting

Determine the need for mobility aids or personal assistance

• 1 Walking cane
• 3 Wheelchair
• 4 Physical therapy
• 5 Occupational therapy

Confirm the patient's ability to take medications correctly

• 1 Excellent
• 1 Forgetting to take medications
• 2 Difficulty opening medication containers
• 3 Confusion with medication dosages
• 4 Side effects management
• 5 Difficulty reading medication labels

Assess the need for special care, like feeding or bathing assistance

• 1 Feeding assistance
• 2 Bathing assistance
• 3 Dressing assistance
• 4 Toileting assistance
• 5 Oral hygiene assistance

Make records of findings and observations during the visit

Discuss potential strategies and solutions with the patient and caregivers, approval: patient's home assessment findings.

• Assess home environment, including entrances, stairs, and bathrooms Will be submitted
• Review the use of home appliances and utilities in detail Will be submitted
• Assess the need for home modifications or additional equipment Will be submitted
• Make note of potential safety risks and hazards Will be submitted
• Evaluate the patient's ability to perform activities of daily living Will be submitted
• Determine the need for mobility aids or personal assistance Will be submitted
• Confirm the patient's ability to take medications correctly Will be submitted
• Assess the need for special care, like feeding or bathing assistance Will be submitted
• Make records of findings and observations during the visit Will be submitted
• Discuss potential strategies and solutions with the patient and caregivers Will be submitted

Develop and finalize a home-based therapy program

Educate patient and caregivers about the recommended changes, schedule follow-up visits or remote check-ins, submit final report to the healthcare team, take control of your workflows today., more templates like this.

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• Advice and support

Home adaptations and occupational therapist assessments

This information applies to England and Wales.

Your occupational therapist (OT) wants to find out what you need to support you in your home.

The OT will also look at your home. They write a report about you and what changes to your housing could make your life easier.

Finding the right equipment and assistive technology

If you do not own your home, you will need permission from your landlord to make any changes to physical features.

Most people are assessed by their local authority, but some care teams also include an OT. Getting an assessment and adaptations can take time. You could also get a private assessment.

Talking to your landlord

Getting an assessment, before your assessment, what happens in an assessment, after the assessment.

You will need to get your landlord’s permission to change any physical features. This could be a private landlord, housing association or your local authority.

If you count as disabled under the Equality Act, you have the right to reasonable adjustments. This means adjustments that do not mean making a physical or structural change to your home.

Definition of disability under the Equality Act 2010 (GOV.UK)

Landlords, disabled tenants and adaptations

Most people get an assessment by asking their local authority’s adult social care team. There may be a waiting list.

If your care team includes an OT, the OT might be able to assess you. Ask them how you could get an assessment.

Getting home adaptations

Contacting your local authority.

Some home adaptation information can be hard to find. Look for a section of your local authority’s website that talks about ‘housing’ or ‘disabled people’. Some pages might be called 'help to stay in the home' or ‘care assessments and housing adaptation’.

Sometimes it’s not clear who you should contact. If you’re not sure, contact your local authority’s general number or email address. They can tell you who to contact or refer you to the correct department. It can help to ask for the Community Occupational Therapy office.

Find your local council (GOV.UK)

Private assessments

If you are planning to pay for your own adaptations, you could pay an OT to assess you. This OT would not be working for your local authority or the NHS.

Paying to be assessed could be faster than waiting for your local authority to assess you. Your local authority or Home Improvement Agency may be able to recommend an OT service.

If you do not own your own home, you will still need permission from your landlord to make changes to physical features.

If you decide to have an OT report from another service or the NHS, check your housing provider will accept this.

Search for a registered Occupational Therapist (Health and Care Professions Council)

Find an Occupational Therapist (Royal College)

Say if you need support in the assessment. For example, if you want:

• someone else there to support you, like a family member, friend or independent advocate
• to see the OT alone, without your parent or carer
• to meet at a particular time of day because of your condition

Getting support and knowing your rights to adaptations can be difficult. An advocate or social worker may be able to help support you with your social care assessment.

Advocates for social care assessments

Advocacy and links to organisations (Disability Rights UK)

Make a list of:

• anything you find difficult to do at home and want them to pay attention to
• what’s important for you to do at home and why
• equipment and adaptations you’ve already tried and reasons why they did or did not work

For example, if you’ve used a shower in a wet room when you’ve not been able to bathe at home.

The OT will visit you at home to see how things are set up there. They want to know:

• what you can do around the home
• what you find difficult to do
• what you need to do things safely

They will ask you questions about:

• how things can be made easier
• what equipment you’ve already tried

They might ask you to show them how you do things. You can say if you do not want to and they will find another way to find out what adaptations might help.

You can ask for a specific adaptation, but the OT will need to understand why you need it.

For example:

“My condition means that I can’t stand safely in my shower or get in and out of my bath. And sitting on a bath board is painful for me.

I’ve tried a shower chair but it doesn’t fit in my shower. Would a wet room with a chair be the best way for me to clean myself?”

The OT will think about what equipment will help you

They will start by thinking about the smallest change that could make the biggest difference. This could be a bath board, bath rails and then maybe a wet room.

If your condition means that you need support with personal care, they may ask you some personal questions.

For example, the OT could ask how you wash.

If a carer helps you to wash, they will ask you how your carer supports you. For example:

• physical help with large or small movements
• getting in and out of the shower or bath
• moving around
• being reminded what you need to do next, verbally or by using pictures

The OT will write a report to show you how they plan to adapt your home.

They may talk to you again about what adaptations they’re going to recommend and why. You can also say why it might or might not work.

They will send this to you and anyone else involved. If you’re a tenant, this might be your:

• private landlord
• housing association
• council housing office

If you have an OT report from another service or the NHS, check with your housing provider if they will accept this. Some housing associations and private landlords, for example, will not accept an NHS report for an adaptations application.

Permission from your landlord

If you do not own your home, you will need permission from your landlord to make changes to the features and structure.

The OT will talk with the person who manages your housing to see how the adaptations could work in your home.

If there’s an adaptation that you need that cannot be made in your home, they might recommend that you move.

Temporary housing during home adaptations

Getting a second opinion

If you do not agree with your local authority’s OT report, you can challenge it.

Challenging recommendations about NHS disability equipment

You could get a private OT assessment for a second opinion. But this can be expensive and there’s no guarantee that the private report will help support your dispute.

Last reviewed by Scope on: 26/02/2024

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More on home adaptations

Asking for an occupational therapy assessment and disability grants for home improvements to make it accessible for a disabled person.

Grants for home adaptations

How to apply for a Disabled Facilities Grant for housing adaptations and home improvements such as an accessible bathroom, extra bedroom or extension.

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• NDIS Occupational Therapy Functional Assessment Template

templates: NDIS Occupational Therapy Functional Assessment Template

Download a Copy of our NDIS Occupational Therapy Functional Assessment Template

Click the button to download now.

How to Use This NDIS Occupational Therapy Report Template

We’ve broken this document into sections that cover the main focus areas of OTs:

• Client information
• NDIS Specific Details
• Introduction
• Client Goals
• Primary Disability
• Medical Background
• Family and Social Support
• Services in Place
• Home Environment
• Activities of Daily Living
• Physical Function
• Recommendations Sections
• Summary Section

You’ll need to focus on all of the above for a holistic OT service. Make your way through our template to ensure you’re aware of best practices in each area.

By implementing these practices and resolving any current issues, you’ll likely deliver services in the best interest of your patient.

About This Resource

At OT Sketch ( home modification software to draw home modifications ) we are passionate about comprehensive and evidence-based assessments being completed by Occupational Therapists.

We acknowledge that Occupational Therapy assessments are comprehensive with a wide range of care needs being covered.

Consequently, an OT report template needs comprehensive to support OTs to efficiently and professionally capture relevant information during their assessments.

We created this resource to support Occupational Therapists to increase the specificity and ease of use of the templates in which they use, in particular when supporting people living with disabilities with funding under the NDIS in Australia.

PS – Want a free trial of OT Sketch? Let us know via our contact page.

12 NDIS Occupational Therapy Report Template Notes

The NDIS can be complex for an Occupational Therapist to navigate and this includes the OT reporting needs of the NDIS.

An Occupational Therapist, and business, need to ensure they are meeting the documentation requirements of bodies such as AHPRA, NDIS and their Insurer.

The following points cover important information that you need to know or consider when creating an OT report template that will support the completion of efficient and professional OT reports.

1 – Understanding the NDIS

At OT Sketch, we like to keep things simple. When creating an NDIS OT report template, it is important to first understand what the NDIS is.

The NDIS stands for the National Disability Insurance Scheme, which is an insurance scheme in Australia for people that are living with disabilities.

That may be a disability that they are born with or a disability that has been acquired during their life.

The NDIS is a federal scheme with partnerships with states and territories throughout Australia, and it is considered a world-leading disability insurance scheme.

The NDIS has specific access requirements defined in the NDIS Act .

The National Disability Insurance Agency ( NDIA ) is responsible for administering the NDIS.

Occupational Therapists supporting NDIS participants will regularly complete OT reports that will be used by NDIS participants as supporting documentation for the NDIA to consider whether supports and interventions (such as home modifications possibly designed with OT Sketch) are considered reasonable and necessary under the NDIS Act (discussed later in this article).

2 – What is a NDIS Occupational Therapy Report Template?

An NDIS Occupational Therapy Report Template refers to a document template that an Occupational Therapist will use when completing and documenting an assessment for an NDIS participant.

There can be many types of different templates depending on the purpose for which that particular template is required.

Some NDIS templates will be company-controlled and the intellectual property of the company.

Whereas, other report templates may be provided by the NDIA , which is the National Disability Insurance Agency, and one example of those is the Assistive-Technology General Template.

An organisation will typically have several types of NDIS OT report templates and our example template would be considered appropriate for NDIS OT functional capacity report template.

Types of NDIS Occupational Therapy Reports

There are many different types of NDIS Occupational Therapy reports, and some of those include:

• Functional Capacity or Functional Assessment Reports
• Home modification reports
• Supported Independent Living (SIL) reports
• Apecialist Disability Accommodation (SDA) reports and;
• Assistive Technology (AT) reports

Difference Between a NDIS and a Non-NDIS Report

At a broad level, the care needs ( which can be identified and assessed in an Occupational Therapy initial assessment and documented in a report ) can be similar between different funding streams.

This may be an older adult through age care programs, or a person living with a disability with funding through the NDIS, or other funding streams such as Lifetime Care and Support.

Some of the predominant differences, however, with an NDIS Occupational Therapy Report will be the specific NDIS terminology that will be used in the report.

Several examples of this specific terminology per the NDIS legislation and act would be:

• Reasonable and necessary
• Assistive technology commonly referred to as AT
• Different levels of complexity of AT such as low, mid and high-cost, or low and high-risk
• Supported Independent Living (SIL)
• Specialist Disability Accommodation (SDA)

There are many more acronyms that are NDIS-specific, which will often make the largest difference in terms of identifying whether an Occupational Therapy report is NDIS-specific or general in nature.

3 – When a Report Template is Used

Common scenarios.

An NDIS participant will often require an Occupational Therapy report for several reasons.

The first time may be to support their access to the NDIS – to become a participant of the NDIS people often require supportive documentation to support the access request for the NDIA to review.

Some of the more common reasons , however, that an Occupational Therapy report would be required by an NDIS participant is to support a plan review to determine what types of reasonable and necessary supports may be indicated in the NDIS participant’s next plan.

An Occupational Therapy report can often be required to identify Assistive Technology or home modifications, or to identify a different change of housing or accommodation need for a participant.

Who Can Request an NDIS Occupational Therapy Report

The parties who commonly request NDIS assessments are:

• The NDIS participant themselves
• Their NDIS Support Coordinator
• A Local Area Coordinator (LAC)
• NDIA Planner

When to Deliver Occupational Therapy Multiple Reports

An NDIS participant can often have multiple OT reports if there are multiple complex care needs requiring support.

Therefore, both a home modification report ( associated drawings and scopes of works ) + Assistive Technology report ( associated trials and quotes ) would be required.

4 – How to Write Professional Reports

In an NDIS Occupational Therapy Report, the language used by the Occupational Therapist will vary depending on the different sections of the report. This is common across all types of Occupational Therapy reports.

An example of this would be in the subjective section of the Occupational Therapy report, some of the language will be from the perspective of the participant themselves ( i.e. self-reported outcome measures & self-reported statements about their goals and identified care needs ).

Throughout the rest of the report, which we could broadly classify as the objective part of the assessment, the language will be much more objective in nature.

Readability of the Report

Having an easy-to-read-and-navigate Occupational Therapy report is critical for consumers and stakeholders alike.

It’s also important for other Allied Health professionals to be able to easily read an Occupational Therapy report in regards to multidisciplinary practice.

The aspects of an Occupational Therapy report to pay attention to are:

• Clear headings
• Clear Summary and Recommendations section
• Clear document structure and separation of sections ( Summary, NDIS Participant Information, NDIS Participant Plan Details, About, Subjective Assessment, Objective Assessment, subheadings to different areas of Activities of Daily Living )

It should also be considered whether a Summary and Recommendation section can be placed towards the front of a report for easy access, as NDIS Occupational Therapy Reports can be quite long, so having a summary on the front or second page can make navigation easy for consumers and stakeholders.

5 – Critical Information Within the Report

The mandatory information within an NDIS Occupational Therapy report can vary .

The reason for the report and the type of NDIS Occupational Therapy report used will alter the final contents.

An example of this is a Functional Assessment report, which can be broad in nature, covering all different types of care needs and activities of daily living, equipment prescriptions and environmental needs for a participant.

An NDIS Occupational Therapy report, however, may often be more specific around assessing and prescribing Assistive Technology.

The nature of that Occupational Therapy report would be much more targeted towards noting specifications of the assistive technology, why that assistive technology represents value for money, documenting trials that have taken place around determining if that assistive technology was suitable for the participant.

Evidence-Based Reporting

Depending on the reason for the NDIS Occupational Therapy Report being requested, the evidence required or provided in the report will be dependent on that request.

Broadly speaking, an NDIA planner or other delegate of the NDIA CEO are the only people that are able to determine whether a recommended support is considered ‘ reasonable and necessary ’ under the NDIS Act.

Therefore, it is the responsibility of the Occupational Therapist to conduct an evidence-based assessment and complete an objective report to identify care needs and recommended interventions that are evidence-based and in line with an NDIS participant’s meaningful goals.

It is not the responsibility of the Occupational Therapist to determine if a support or intervention will be considered reasonable and necessary by the NDIA.

Demonstrating Progress Towards Goals

Arguably, meaningful goals of an NDIS participant ( or any consumer that an Occupational Therapist is supporting ) are one of the the most important components of the assessment or report to identify and document.

One of the primary reasons that Occupational Therapists are in practice; is to support those we care for to move towards achieving their meaningful goals.

Goals can be quite broad in nature; in terms of working towards independence in different areas of activities of daily living, or leisure and employment.

At other times, goals may be more specific to improving different outcome measures relating to the risk of acquiring a associated medical conditions ( i.e. falls or pressure area risk outcome measures improving as part of a goal ).

One of the most important pieces to identify in goal-setting and progress-tracking is around SMART goal-setting.

Representing Value for Money

Value for money is an example of an NDIS-specific piece of terminology, however, is occasionally used under other funding streams too.

For an Occupational Therapist, va lue for money means that when recommending support or interventions you should consider and document whether it represents value for money for the NDIS and its expenditure as a scheme in the short, medium and long term .

A simple example of this concept is an Occupational Therapist who may review the need for a specific type of wheelchair for an NDIS participant.

The OT may identify two different chairs that meet the participant’s care needs and meaningful goals.

For example, there may be a price difference where one wheelchair is significantly dearer in the short term, however, it provides significant value for money and cost savings in the long term.

This could be due to different functional abilities of the chair, which may decrease the need for the NDIS participant to receive extensive personal care support and community transport funding.

The chair may also have much longer lifespan in terms of replacement and repair costs.

Value for money is an ingrained piece of terminology that NDIA planners, LACs and other stakeholders in the NDIS will reference.

Reasonable and Necessary

Reasonable and necessary is another example of very NDIS-specific terminology.

Simply put, reasonable and necessary is inbuilt into the NDIS Act ( the legislation by which the NDIA must adhere to ) to help govern operations of the NDIS.

As previously stated, the NDIA CEO or delegate of is the only party that is able to determine whether a support or service is deemed reasonable and necessary under the NDIS Act.

There are certain criteria within the NDIS Act that must be adhered to by the NDIA CEO or delegate in determining whether a support is reasonable and necessary.

Broadly speaking, reasonable and necessary supports or services need to be considered:

• Must be related to a participant’s disability
• Must not include day-to-day living costs not related to your disability support needs, such as groceries
• Should represent value for money
• Must be likely to be effective and work for the participant, and
• Should take into account support given to you by other government services, your family, carers, networks and the community.

Providing Clear Recommendations

An important part of an Occupational Therapy report is clear and actionable recommendations .

A recommendation section should be on the summary page ( first 1-2 pages of the report ) or at the very end.

In the recommendation section, each recommendation should have its own area, which can be numbered or bulleted.

One example of a clear recommendation could be:

• Outcome: the care need is pressure area risk
• Recommendation: The recommendation will be purchase of recommended pressure area cushion as identified in successful trial to be purchased by NDIS participant. Occupational Therapist has provided NDIS participant with quote.

It is recommended that a care need be associated with the recommendation, and the action to be clear with who is responsible for that action.

6 – NDIS Specific Information

Ndis occupational therapy reports to support ndis reviews or appeals.

An NDIS Occupational Therapy Report is often used as supporting evidence by an NDIS participant or NDIS nominee.

A NDIS nominee is somebody with the power to act on behalf of an NDIS participant, including during an NDIS review or appeals process.

An NDIS planner will be able to refer to the NDIS Occupational Therapy Report and other supporting evidence provided by the participant or nominee to make a determination whether the recommended supports or interventions are deemed reasonable and necessary against the NDIS Act.

Submission to the NDIA

An NDIS Occupational Therapy report should be submitted to the NDIA in the way in which the NDIS participant, or their plan nominee consents.

This may be directed to the NDIA via their general inquiries email. However, there are several other ways reports can be submitted to the NDIA.

• This could be by providing the report to the participant or their plan nominee, and they will provide that to the agency, possibly through the NDIS portal
• Other avenues, with consent, maybe through to a local area coordinator, or their support coordinator
• Other times, it may be appropriate and deemed necessary to provide that directly to an NDIA planner that is already engaged in a process of supporting the participant through something, such as a plan review

Feedback on Reports from the NDIA

It is common for a NDIS participant, NDIA planner, local area coordinator, or support coordinator to provide advice and recommendations for an Occupational Therapist to consider regarding their Occupational Therapy report.

This can be providing the Occupational Therapist with additional information that was not provided or accessible for the Occupational Therapist at the time of report.

This could also include new information, or a change in care needs, or status for an NDIS participant, such as where they live, or the status of their disability and required care needs.

At times, there may also be feedback regarding additional information required in an Occupational Therapy report to support an NDIA planner to make a decision against the reasonable and necessary criteria of the NDIS Act.

7 – Reading & Sharing Reports

It is important to note that an NDIS participant, or their plan nominee have the power and authority to provide consent to who that report is provided to and read by.

An NDIS Occupational Therapy report can be read by many people .

First and foremost, it can be read by the NDIS participant, their plan nominee, family and/or friends (with consent).

It is important part of an Occupational Therapist’s practice, or their organisation’s procedures to have clear consent processes in place. Typically this takes form in a service agreement document.

The service agreement will list who has been granted consent by the NDIS participant as to who can access the information inside the report.

With consent, the report may also be provided to other stakeholders ( such as GPs, LACs, support staff, support coordinators and the NDIA staff).

It is important to keep in mind, when completing a report, that it may be read by many parties. Maintaining objectivity and professional language throughout the report is very important.

8 – Managing Templates Within an Organisation

There are different ways in which organisations manage their documentation/report templates.

Typically, an organisation will be using either practice management software and/or workplace software such as Microsoft 365 or Google Workspace.

These types of systems have report template functions and document library features.

An important part of documentation management is making sure that organisations have a documentation register to track what report templates they actually have, where they are located, when they are updated and with previous versions archived.

9 – Support from Consulting Organisations

There are many consulting organisations in Australia that support Allied Health organisation or Allied Health professionals.

Common situations for consultation include:

• Supporting OTs with their NDIS registration against the NDIS practice standards
• Supporting OTs with verification or certification pathways ( required to offer services to NDIA-managed NDIS participants)
• General business operations, development of SOPs, recruitment, etc

In terms of support that is specific to Occupational Therapy report templates, there are fewer options in the market.

Well-established Allied Health providers, such as Community Therapy offer consultancy services for Allied health organisations.

10 – Professional Development for OT Graduates

Graduates learning to operate under the ndis.

An Occupational Therapist new graduate may have had some exposure to supporting NDIS participants as part of their undergraduate placements.

Regardless of this, Occupational Therapists should be supported by their organisation in their onboarding and general supervision through their first year as a clinician to increase their knowledge of the NDIS.

In combination with this, Occupational Therapists against their standards with AHPRA are responsible for their own continuing professional development each year.

And as part of that, if supporting NDIS participants should be actively seeking to upskill their own knowledge against the NDIS requirements.

Occupational Therapists in Australia should review CPD opportunities offered by Occupational Therapy Australia .

Learning NDIS Occupational Therapy Report Template Writing

Most small, medium and large Allied Health organisations will have their own NDIS Occupational Therapy reports.

It is standard practice ( as part of onboarding, supervision and induction periods ) for OTs to be provided with buddying/training on how to complete the different types of reports that the organisation completes.

Occupational Therapists can reach out to colleagues, or Occupational Therapy Australia for required support. This is more commonly the case for sole traders or small organisations.

11 – Following Up After Delivering an Occupational Therapy Report

Under the NDIS Act, the NDIA ( who is responsible for operating the scheme ) has timelines imposed on it in terms of providing responses back to NDIS participants around the status of their requests.

These situations may be a change in circumstances, a request for a review of their plan, or a request for a determination of if interventions, recommendations are deemed reasonable and necessary .

Those timelines can vary depending on the nature of the request however are commonly 28 days for many types of requests.

As part of an Occupational Therapy report that is focused on home modifications, whether minor or major, the most important part of that report is having a clear drawing and associated Scope of Works and quotes.

This is for the NDIA to make a determination of whether those modifications are deemed reasonable or necessary.

It can be quite complex ( as many may know!! ) to accurately and easily draw home modifications both in 2D and 3D landscapes.

OT Sketch solves that problem by making it easy for Occupational Therapists to accurately and easily draw minor and major home modifications.

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CEO. Scott is a Physiotherapist and co-founder of OT Sketch. In his clinical practice, he has proudly employed a team of over 95 Physios and OTs.

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40 facts about elektrostal.

Written by Lanette Mayes

Modified & Updated: 02 Mar 2024

Reviewed by Jessica Corbett

Elektrostal is a vibrant city located in the Moscow Oblast region of Russia. With a rich history, stunning architecture, and a thriving community, Elektrostal is a city that has much to offer. Whether you are a history buff, nature enthusiast, or simply curious about different cultures, Elektrostal is sure to captivate you.

This article will provide you with 40 fascinating facts about Elektrostal, giving you a better understanding of why this city is worth exploring. From its origins as an industrial hub to its modern-day charm, we will delve into the various aspects that make Elektrostal a unique and must-visit destination.

So, join us as we uncover the hidden treasures of Elektrostal and discover what makes this city a true gem in the heart of Russia.

Key Takeaways:

• Elektrostal, known as the “Motor City of Russia,” is a vibrant and growing city with a rich industrial history, offering diverse cultural experiences and a strong commitment to environmental sustainability.
• With its convenient location near Moscow, Elektrostal provides a picturesque landscape, vibrant nightlife, and a range of recreational activities, making it an ideal destination for residents and visitors alike.

Known as the “Motor City of Russia.”

Elektrostal, a city located in the Moscow Oblast region of Russia, earned the nickname “Motor City” due to its significant involvement in the automotive industry.

Home to the Elektrostal Metallurgical Plant.

Elektrostal is renowned for its metallurgical plant, which has been producing high-quality steel and alloys since its establishment in 1916.

Boasts a rich industrial heritage.

Elektrostal has a long history of industrial development, contributing to the growth and progress of the region.

Founded in 1916.

The city of Elektrostal was founded in 1916 as a result of the construction of the Elektrostal Metallurgical Plant.

Located approximately 50 kilometers east of Moscow.

Elektrostal is situated in close proximity to the Russian capital, making it easily accessible for both residents and visitors.

Known for its vibrant cultural scene.

Elektrostal is home to several cultural institutions, including museums, theaters, and art galleries that showcase the city’s rich artistic heritage.

A popular destination for nature lovers.

Surrounded by picturesque landscapes and forests, Elektrostal offers ample opportunities for outdoor activities such as hiking, camping, and birdwatching.

Hosts the annual Elektrostal City Day celebrations.

Every year, Elektrostal organizes festive events and activities to celebrate its founding, bringing together residents and visitors in a spirit of unity and joy.

Has a population of approximately 160,000 people.

Elektrostal is home to a diverse and vibrant community of around 160,000 residents, contributing to its dynamic atmosphere.

Boasts excellent education facilities.

The city is known for its well-established educational institutions, providing quality education to students of all ages.

A center for scientific research and innovation.

Elektrostal serves as an important hub for scientific research, particularly in the fields of metallurgy, materials science, and engineering.

Surrounded by picturesque lakes.

The city is blessed with numerous beautiful lakes, offering scenic views and recreational opportunities for locals and visitors alike.

Well-connected transportation system.

Elektrostal benefits from an efficient transportation network, including highways, railways, and public transportation options, ensuring convenient travel within and beyond the city.

Famous for its traditional Russian cuisine.

Food enthusiasts can indulge in authentic Russian dishes at numerous restaurants and cafes scattered throughout Elektrostal.

Home to notable architectural landmarks.

Elektrostal boasts impressive architecture, including the Church of the Transfiguration of the Lord and the Elektrostal Palace of Culture.

Offers a wide range of recreational facilities.

Residents and visitors can enjoy various recreational activities, such as sports complexes, swimming pools, and fitness centers, enhancing the overall quality of life.

Provides a high standard of healthcare.

Elektrostal is equipped with modern medical facilities, ensuring residents have access to quality healthcare services.

Home to the Elektrostal History Museum.

The Elektrostal History Museum showcases the city’s fascinating past through exhibitions and displays.

A hub for sports enthusiasts.

Elektrostal is passionate about sports, with numerous stadiums, arenas, and sports clubs offering opportunities for athletes and spectators.

Celebrates diverse cultural festivals.

Throughout the year, Elektrostal hosts a variety of cultural festivals, celebrating different ethnicities, traditions, and art forms.

Electric power played a significant role in its early development.

Elektrostal owes its name and initial growth to the establishment of electric power stations and the utilization of electricity in the industrial sector.

Boasts a thriving economy.

The city’s strong industrial base, coupled with its strategic location near Moscow, has contributed to Elektrostal’s prosperous economic status.

Houses the Elektrostal Drama Theater.

The Elektrostal Drama Theater is a cultural centerpiece, attracting theater enthusiasts from far and wide.

Popular destination for winter sports.

Elektrostal’s proximity to ski resorts and winter sport facilities makes it a favorite destination for skiing, snowboarding, and other winter activities.

Promotes environmental sustainability.

Elektrostal prioritizes environmental protection and sustainability, implementing initiatives to reduce pollution and preserve natural resources.

Home to renowned educational institutions.

Elektrostal is known for its prestigious schools and universities, offering a wide range of academic programs to students.

Committed to cultural preservation.

The city values its cultural heritage and takes active steps to preserve and promote traditional customs, crafts, and arts.

Hosts an annual International Film Festival.

The Elektrostal International Film Festival attracts filmmakers and cinema enthusiasts from around the world, showcasing a diverse range of films.

Encourages entrepreneurship and innovation.

Elektrostal supports aspiring entrepreneurs and fosters a culture of innovation, providing opportunities for startups and business development.

Offers a range of housing options.

Elektrostal provides diverse housing options, including apartments, houses, and residential complexes, catering to different lifestyles and budgets.

Home to notable sports teams.

Elektrostal is proud of its sports legacy, with several successful sports teams competing at regional and national levels.

Boasts a vibrant nightlife scene.

Residents and visitors can enjoy a lively nightlife in Elektrostal, with numerous bars, clubs, and entertainment venues.

Promotes cultural exchange and international relations.

Elektrostal actively engages in international partnerships, cultural exchanges, and diplomatic collaborations to foster global connections.

Surrounded by beautiful nature reserves.

Nearby nature reserves, such as the Barybino Forest and Luchinskoye Lake, offer opportunities for nature enthusiasts to explore and appreciate the region’s biodiversity.

Commemorates historical events.

The city pays tribute to significant historical events through memorials, monuments, and exhibitions, ensuring the preservation of collective memory.

Promotes sports and youth development.

Elektrostal invests in sports infrastructure and programs to encourage youth participation, health, and physical fitness.

Hosts annual cultural and artistic festivals.

Throughout the year, Elektrostal celebrates its cultural diversity through festivals dedicated to music, dance, art, and theater.

Provides a picturesque landscape for photography enthusiasts.

The city’s scenic beauty, architectural landmarks, and natural surroundings make it a paradise for photographers.

Connects to Moscow via a direct train line.

The convenient train connection between Elektrostal and Moscow makes commuting between the two cities effortless.

A city with a bright future.

Elektrostal continues to grow and develop, aiming to become a model city in terms of infrastructure, sustainability, and quality of life for its residents.

In conclusion, Elektrostal is a fascinating city with a rich history and a vibrant present. From its origins as a center of steel production to its modern-day status as a hub for education and industry, Elektrostal has plenty to offer both residents and visitors. With its beautiful parks, cultural attractions, and proximity to Moscow, there is no shortage of things to see and do in this dynamic city. Whether you’re interested in exploring its historical landmarks, enjoying outdoor activities, or immersing yourself in the local culture, Elektrostal has something for everyone. So, next time you find yourself in the Moscow region, don’t miss the opportunity to discover the hidden gems of Elektrostal.

Q: What is the population of Elektrostal?

A: As of the latest data, the population of Elektrostal is approximately XXXX.

Q: How far is Elektrostal from Moscow?

A: Elektrostal is located approximately XX kilometers away from Moscow.

Q: Are there any famous landmarks in Elektrostal?

A: Yes, Elektrostal is home to several notable landmarks, including XXXX and XXXX.

Q: What industries are prominent in Elektrostal?

A: Elektrostal is known for its steel production industry and is also a center for engineering and manufacturing.

Q: Are there any universities or educational institutions in Elektrostal?

A: Yes, Elektrostal is home to XXXX University and several other educational institutions.

Q: What are some popular outdoor activities in Elektrostal?

A: Elektrostal offers several outdoor activities, such as hiking, cycling, and picnicking in its beautiful parks.

Q: Is Elektrostal well-connected in terms of transportation?

A: Yes, Elektrostal has good transportation links, including trains and buses, making it easily accessible from nearby cities.

Q: Are there any annual events or festivals in Elektrostal?

A: Yes, Elektrostal hosts various events and festivals throughout the year, including XXXX and XXXX.

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Metallurgicheskii Zavod Electrostal AO (Russia)

In 1993 "Elektrostal" was transformed into an open joint stock company. The factory occupies a leading position among the manufacturers of high quality steel. The plant is a producer of high-temperature nickel alloys in a wide variety. It has a unique set of metallurgical equipment: open induction and arc furnaces, furnace steel processing unit, vacuum induction, vacuum- arc furnaces and others. The factory has implemented and certified quality management system ISO 9000, received international certificates for all products. Elektrostal today is a major supplier in Russia starting blanks for the production of blades, discs and rolls for gas turbine engines. Among them are companies in the aerospace industry, defense plants, and energy complex, automotive, mechanical engineering and instrument-making plants.

Headquarters Ulitsa Zheleznodorozhnaya, 1 Elektrostal; Moscow Oblast; Postal Code: 144002

Contact Details: Purchase the Metallurgicheskii Zavod Electrostal AO report to view the information.

Website: http://elsteel.ru

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