RECREATION THERAPY DISCHARGE SUMMARY
|FORM # |
|NAME OF HOSPITAL |
|RECREATION THERAPY DISCHARGE SUMMARY |
|Client: | |SS#: | |Center Program: | |
|Admission Date: | | |Center Counselor: | |
|Discharge Date: | | |Field Counselor: | |
|Staff Signature: | |Date: | |
| | | | |
|Diagnosis/Rehab. Problem: | |
| |
|Rehab. Goal: | |
| |
|R.T. Goal: | |
| |
|R.T. Objectives: | |
| |
| |
|Interventions Utilized: | |Adaptive Equipment Utilized: |
| |Aquatics | |Cognitive Activities | |Scissors (Loop) |
| |Relaxation | |Physical Conditioning | |Pencil Grip |
| |Horticulture | |Outdoor Activities | |Magnifying Glass |
| |Arts & Crafts | |Leisure Counseling | |Card Holders |
| |Sports | |Social Activities | |Talking Books |
| |Spectator Events | |Community Reintegration | |Bowling Buddy(ramps, etc.) |
| |Leisure Exploration | |Other: | | | |Cuffs or Braces |
| |Computers | | | | |Other: | |
| | | | | | | | |
|Leisure Barriers at Discharge: | |
| |Cognitive Skills | |Social Skills/Approp. | |Communication |
| |Paralysis | |Financial | |General Weakness |
| |ROM Limitations | |Mobility | |Endurance |
| |Perceptual Problems | |Grasp/Release | |Fears/Phobias |
| |Hearing Deficits | |Visual Acuity | |Motivation |
| |Spasticity | |Pain | |Other: | |
| |Attitude | |Self Confidence | | |
| | |
|Progress Achieved: | |
| |
| |
|Discharge Recommendations: | |
| |Utilization of Community Resources | |Adaptive equipment requested | |
| |Continue program at home | | |
| |Encouragement of social/leisure participation | | |
| | | | |
|Reason for Discharge: | | | |
| |Completed TR Program | |Medical Leave | |Refusal to participate |
| |Lack of participation / interest | |Completed Medical Tx. Program | |Self Termination |
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