Therapist Name: ____________________
Client Name: ______________________
Date: ________________
________________________________________________
S Focus for today?
Symptoms: Location/Intensity/Frequency/Duration/Onset
Activities of Daily Living: Aggravating/Relieving
O Findings: Visual/Palpable/Test Results
Modalities: Applications/Locations
Response to Treatment (see A)
A Prioritize Functional Limitations
Goals: Long-term/Short-term
P Future Treatment/Frequency
Homework/self-care
________________________________________________________________________________________________
Therapist Signature _______________________
Date _________________
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