PHYSICAL THERAPY PROGRESS REPORT

Patient: [Name]
Date of birth: [Date]
Date of report: [Date]
Reporting period: [First and last date covered]
Visits to date: [Visits attended, canceled, and missed]
Treatment diagnosis: [Condition and body region]
Referring clinician: [Name, if any]
Therapist: [Name, credentials]

SUMMARY OF CARE
Interventions provided: [Main interventions this period]
Patient report: [Change in symptoms and function since the evaluation or last report]
Home program adherence: [How consistently it is done]

MEASURES
Pain: Initial [score out of 10] | Now [score out of 10]
Range of motion: Initial [joint, motion, degrees] | Now [degrees] | Other side [degrees]
Strength: Initial [muscle group, grade] | Now [grade] | Other side [grade]
Balance or gait: Initial [test, result] | Now [result]
Outcome measure: Initial [name, score] | Now [score] | Change [points]

GOAL STATUS
Goal 1: [Goal] | Baseline [value] | Now [value] | Status [met, progressing, or not met]
Goal 2: [Goal] | Baseline [value] | Now [value] | Status [met, progressing, or not met]
Goal 3: [Goal] | Baseline [value] | Now [value] | Status [met, progressing, or not met]

ASSESSMENT
Progress: [What changed, and whether the change is meaningful for function]
Remaining limitations: [Impairments and activity limitations still present]
Barriers: [Anything slowing progress, and how you are addressing it]

UPDATED GOALS
New or revised goals: [Measurable, functional, with a time frame]

RECOMMENDATION
Decision: [Continue, change the plan, or discharge]
Justification: [Why skilled care is still needed, or why it no longer is]
Plan: [Frequency, duration, and changes to interventions]
Report sent to: [Referring clinician or others]

Signed: [Clinician name, credentials, date and time]