Responsibility, Skill, or Procedure
Yes
No
Coordinates effectively with other members of the Home Care Team :

In conjunction with patient, physician and home care team carries out the OT plan of care based on patient needs and appropriate interventions

Thoroughly and accurately evaluates and documents the patient’s status relative to:

Patient’s functional status

Muscle function

Endurance

Visual coordination

Written and verbal communication skills

Self-care ability

Work capacity

Evaluates the patient’s home environment relative to :

Hazards

Barriers to independent living

In-home safety checklist

Reviews, discusses and instructs patients, families and caregivers in :

Activities of daily living based on the plan of care

Use of various types of adaptive equipment to improve function

Use of prosthetic and/or orthotic devices

In-home safety factors and techniques

Completes the following medical records thoroughly, timely and accurately :

Progress Notes (as needed)

Discharge/Transfer Record

Clearly communicates with Occupational Therapist regarding :

Observations & Clinical Changes

Concerns

Identifies and assists client/family in accessing community resources including :

Assists OT in finding resources for assistive, prosthetic or orthotic devices/supplies

Access to other resources through referral to other team members or community programs relative to client’s needs

Communicates appropriately with the other members of healthcare team including :

Nurse

Occupational Therapist

Physical Therapist

Physical Therapy Assistant

Speech Therapist

Social Service

Home Health Aide

Other: (identify) :

Other areas/skills :

Performs teaching to client/family/home health aide

Maintains client confidentiality/HIPAA

Conducts self in a professional manner

Reports to Supervisor as needed and appropriate

Maintains Infection Control Guidelines for hand washing, etc

Participates in interdisciplinary/case/team conferences as needed

My signature below does not imply my agreement with the content of this evaluation, but that the above evaluation has been reviewed with me.