Updates

  • 2/3/2020 – Version 1 released

About the Free Tx Template

Tx Template Featured Image

  • Easily foldable and printable 2×2 (4 total clients) PDF for OTs to use in rehab settings (Acute/ARU/SNF/Outpatient/Home Health).
  • Uses: Functional screens, Evaluations, Treatments, Re-assessments, and more.
  • Includes: client identifier, order information, nurse information, diagnosis, past medical history, cognition, precautions, chief complaint, pain assessment, dysphagia level, vitals, transfers, ADLs, client performance skills, prior level of function, discharge recommendations, and extra notes.
  • Feel free to edit the template to your needs.
  • Share this with your friends & colleagues!

Abbreviations Explained

  • Tx – treatment
  • RA – re-assessment
  • Freq – frequency
  • Exp – expiration
  • Dx – diagnosis
  • RN – nurse
  • Ext – nurse extension
  • PMH – past medical history
  • A&O – alert and oriented
  • C/C – chief complaint
  • BP – blood pressure
  • HR – heart rate
  • RR – respiration rate
  • O2 – oxygen
  • NPO – nothing by mouth
  • SPC – single point cane
  • SBQC – small base quad cane
  • LBQC – large base quad cane
  • Hemi-W – hemi-walker
  • 4WW – four wheel walker
  • FWW – front wheel walker
  • PFWW – platform front wheel walker
  • WC – wheelchair
  • I – independent
  • S – supervised
  • SBA – stand by assist
  • CGA – contact guard assist
  • Min – minimal assist
  • Mod – moderate assist
  • Max – maximal assist
  • D – dependent
  • ROM – range of motion
  • MMT – manual muscle test
  • PLOF – prior level of function
  • DME – durable medical equipment recomendations
  • OT POC – OT plan of care
  • HH – home health
  • OP- outpatient
  • DC OT – discharge OT

Free Download

Download & Print (Printable .pdf) Download Word (Editable .docx)

LEAVE A REPLY

Please enter your comment!
Please enter your name here