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.

MMT Re-Measurement (0-5)

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.

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):

Reviewing PT signature (printed name):

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.