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Physical Therapy Clinic

Initial evaluation, treatment plan and goals, daily treatment notes, progress re-assessment, and discharge summary with home program for outpatient physical therapy and rehabilitation clinics

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Progress Re-Assessment

A scheduled re-assessment to compare current findings with baseline, score outcome measures, and decide whether to continue, modify, or progress toward discharge.

Re-Assessment Header

Patient name:

Re-assessment date:

Total sessions to date:

Weeks since start of episode:

Reviewing physical therapist:

Pain Re-Measurement

Current VAS (0-10):

Baseline VAS (from initial evaluation):

Pain pattern changes (location, character, frequency):

ROM Re-Measurement

For each motion, record baseline AROM, current AROM, and change in degrees.

Joint / Motion	Baseline	Current	Change
Joint 1:
Joint 2:
Joint 3:
Joint 4:
Joint 5:
Joint 6:

MMT Re-Measurement (0-5)

Muscle	Baseline	Current	Change
Muscle 1:
Muscle 2:
Muscle 3:
Muscle 4:
Muscle 5:
Muscle 6:

Special Tests Re-Run

Test 1: Result:

Test 2: Result:

Test 3: Result:

Outcome Measure Re-Score

Selected measure (Oswestry / DASH / KOOS / LEFS / etc.):

Baseline score: Current score: Change:

Minimal clinically important difference (MCID) reached:

Functional Status

ADL improvements observed:

Specific functional milestones reached:

Remaining functional limitations:

Goal-Attainment Scoring

For each goal: 1 = no progress, 5 = fully attained.

Goal	Original target	Status	Rating (1-5)
Goal 1
Goal 2
Goal 3

Comments on goal progress:

Patient Satisfaction & Self-Report

Overall satisfaction (1-5):

What's working well?

What isn't working? What would you like to change?

Plan Adjustments

Plan decision (continue / modify / progress toward discharge):

Modify modalities (which / how):

Modify exercise program (progression / regression / new emphasis):

Refer for imaging / specialist consult (if indicated):

Discharge readiness:

Discharge Readiness Indicators

Indicators present (PT documents below):

Next Re-Assessment Date

Scheduled for:

Signatures

Patient signature (printed name):

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Reviewing PT signature (printed name):

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Signing date:

I have reviewed this re-assessment and agree with the proposed adjustments

Re-assessment complete. Use the updated plan to guide the next phase of care, and keep noting changes between visits — your feedback shapes the program.

Use this template

About this template

The Progress Re-Assessment template is a ready-to-use form from Pocper's Physical Therapy Clinic pack. Customize the fields to match your workflow, then share a link so clients can complete it and upload documents in real time.

What's in this template

Progress Re-Assessment
Re-Assessment Header
Pain Re-Measurement
ROM Re-Measurement
MMT Re-Measurement (0-5)
Special Tests Re-Run
Outcome Measure Re-Score
Functional Status
Goal-Attainment Scoring
Patient Satisfaction & Self-Report
Plan Adjustments
Discharge Readiness Indicators

Frequently asked questions

What is the Progress Re-Assessment template for?

It's a structured form you send to clients to collect the information, documents, and signatures a physical therapy clinic workflow needs — without the back-and-forth of email.

Can I edit this template?

Yes. Import it into your Pocper workspace, then add, remove, or reword any field before sharing it. Every template is fully editable.

How do clients fill it out?