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PT Evaluation Checklist

Medical

PT Evaluation Checklist

📋

PT Evaluation Checklist

1

Schedule appointment with patient

2

Prepare Evaluation Form

3

Review patient's medical history

4

Perform Physical Screening

5

Assess patient's strength

6

Evaluate patient's range of motion

7

Examine patient's balance

8

Gauge patient's cardio-respiratory endurance

9

Check patient's neuro-muscular coordination

10

Approval: Physical Assessment

11

Determine patient's mobility

12

Identify functional limitations

13

Set realistic treatment goals

14

Develop plan of care

15

Approval: Treatment Plan

16

Document findings and treatment plan

17

Discuss findings and plan with patient

18

Get patient's consent for treatment

19

Schedule follow-up visit

20

Prepare for next patient visit

Schedule appointment with patient

Please schedule an appointment with the patient in a timely manner. This is the first step in the evaluation process and will allow the patient to come in for their assessment. The appointment should be convenient for the patient and fit within their schedule. Make sure to provide the patient with all the necessary information for their visit, such as the date, time, and location of the appointment.

Appointment Date

Appointment Time

1

8:00 AM
2

10:00 AM
3

1:00 PM
4

3:00 PM
5

5:00 PM

Appointment Location

Prepare Evaluation Form

Review patient's medical history

Perform Physical Screening

Assess patient's strength

Evaluate patient's range of motion

Examine patient's balance

Gauge patient's cardio-respiratory endurance

Check patient's neuro-muscular coordination

Approval: Physical Assessment

Perform Physical Screening
Will be submitted
Assess patient's strength
Will be submitted
Evaluate patient's range of motion
Will be submitted
Examine patient's balance
Will be submitted
Gauge patient's cardio-respiratory endurance
Will be submitted
Check patient's neuro-muscular coordination
Will be submitted

Determine patient's mobility

Identify functional limitations

Set realistic treatment goals

Develop plan of care

Approval: Treatment Plan

Determine patient's mobility
Will be submitted
Identify functional limitations
Will be submitted
Set realistic treatment goals
Will be submitted
Develop plan of care
Will be submitted

Document findings and treatment plan

Discuss findings and plan with patient

Schedule follow-up visit

Prepare for next patient visit

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