"Daily Physical Therapy Notes Template"

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Physical Therapy
Daily Notes
Student’s Name: ___________________ Date of Birth: ___________________
School: _____________________________ Therapist: ______________________
Date of Service: ________________
_____Direct Treatment
_____Consultation
_____Individual
_____Group
Treatment Provided:
Gait Training
Professional Training
Wheel Chair
Management
Transfer Training
Positioning
Coordination
Stair Climbing
Motor Planning
Adaptive Equipment
Range of Motion
Strengthening
Therapeutic
Handling
Functional Skills
Balance
Gross Motor Skills
Other
Outcome:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
______________________________
_________
_______________________________________
Signature of PT/PTA,
Date
Signature of Supervising PT
Physical Therapy
Daily Notes
Student’s Name: ___________________ Date of Birth: ___________________
School: _____________________________ Therapist: ______________________
Date of Service: ________________
_____Direct Treatment
_____Consultation
_____Individual
_____Group
Treatment Provided:
Gait Training
Professional Training
Wheel Chair
Management
Transfer Training
Positioning
Coordination
Stair Climbing
Motor Planning
Adaptive Equipment
Range of Motion
Strengthening
Therapeutic
Handling
Functional Skills
Balance
Gross Motor Skills
Other
Outcome:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
______________________________
_________
_______________________________________
Signature of PT/PTA,
Date
Signature of Supervising PT