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

Responds in a timely manner to referrals to admit/assess patient

In conjunction with patient, physician and home care team develops 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 :

Occupational Therapy Assessment

OASIS Documentation

Progress Notes (as needed)

Discharge/Transfer Record

Clearly communicates with Occupational Therapist regarding :

Plan of Care development and changes (HCFA 485)

Observations & Clinical Changes

Obtaining verbal orders

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

Finding resources for assistive, prosthetic or orthotic devices/supplies

Fabricates splints for patients as needed

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

Communicates appropriately with the other members of healthcare team including :

Nurse

Physical Therapist

Speech-Language Pathologist

Medical Social Worker

Home Health Aide

Other: (identify) :

Supervision of COTA :

Performs COTA Supervisory Visits every 30 days

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.