Progress Note Assessment Writing Template

Patient: _______________________________

Date: _______________

A: Patient presents with (Impairments):

1. Pain
2. Swelling
3. Stiffness
4. Decreased ROM
5. Muscular/Capsular Length
6. Weakness
7. Patterns of Recruitment
8. Other_________
impairment(s) of the ____________ body region/joint(s),
resulting in the movement impairment of ______________________
which causes the Functional Limitations of:
1. Posture
2. Sleeping
3. Bed Mobility
4. Sit
5. Transfer
6. Stand
7. Balance
8. ADL
9. Gait
10. Lifting
11. Traveling
12. Vocational
13. Repetitive Motion
14. Recreational
15. Social Activities
16. Sexual Activities
___________ Functional Limitation(s). Patient needs physical therapy for treatment of
the primary Impairment of ______________ to enhance the patients functional capacity
and rehabilitation potential. Given the patients positive/negative response to
intervention, the movement impairment diagnosis of : ____________________________
is confirmed/refuted and the rehabilitation prognosis is excellent/good/fair /poor.
Patient can now: ____________function. Patient still cannot: ___________function.
Changes to the POC will be:_________________________________________.
SportsMedicine of Atlanta is credentialed by the American Physical Therapy Association as a
postprofessional clinical fellowship program for physical therapists in Orthopaedic Manual Therapy.
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