Occupational therapy programs tables of content


INTEREST CHECKLIST PROCEDURES



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INTEREST CHECKLIST PROCEDURES

This form is to be completed by the patient. If the patient is unable to complete independently, the therapist, family member or caregiver can assist the patient with the task.


Have the patient write in name and date that the checklist is being completed. Have the patient check the level of most recent involvement in each of the activities listed (“I already do this”) as also check whether he or she has any desire to continue with the interest or would like to develop new interests (“I would like to do this”). List any other activity/interest in which the patient participates and has a desire to continue or any additional interests he or she would like to develop.
INTEREST CHECKLIST
Name:_____________________________________________________ Date:_____________
PLEASE CHECK THE APPROPRIATE BOXES FOR EACH ACTIVITY:
ACTIVITY (I ALREADY DO THIS) (I WOULD LIKE TO DO THIS)




OFTEN

RARELY

NEVER

OFTEN

RARELY

NEVER

SEDENTARY



















watching TV



















watching sports



















puzzles



















reading



















radio



















movies



















writing



















GAMES



















table games



















cards



















solitaire



















poker



















chess



















checkers



















Scrabble



















SOCIAL/COMMUNITY



















clubs



















religious activities



















service groups



















conversation



















dancing



















parties



















politics



















shopping



















OUTDOOR



















gardening



















camping







































Continues.........


PLEASE CHECK THE APPROPRIATE BOXES FOR EACH ACTIVITY:
ACTIVITY (I ALREADY DO THIS) (I WOULD LIKE TO DO THIS)




OFTEN

RARELY

NEVER

OFTEN

RARELY

NEVER

HANDWORK



















sewing



















crocheting



















mending



















knitting



















embroidery



















needlepoint



















cross-stitch



















HOUSEWORK



















dust



















iron



















cook



















laundry



















CRAFTS



















mosaics



















copper tooling



















ceramics



















decoupage



















macrane5



















leather tooling



















latch hook



















SPORTS



















swimming



















tennis



















volleyball



















Ping-Pong



















weight lifting



















aerobic exercise



















OTHER



















painting



















photography





















Daily Activities

After Your

Hip Surgery


Developed by:

Janet Verner Platt, OTR/L

Robin Hahn, OTR/L

Susan Kessler, MS, OTR/L

Diane Q. McCarthy, MS, OTR/L

Occupational Therapy Division

Georgetown University Hospital

Washington, D.C.


The American Occupational Therapy Association, Inc.

1383 Piccard Drive, PO Box 1725

Rockville, MD 20850-0822

INSERT 15 PAGES RE: DAILY ACTIVITIES AFTER YOUR HIP SX HERE!

OCCUPATIONAL THERAPY

PROGRAMS

Section 23


PROGRAM: WHEELCHAIR PRESCRIPTION
DESCRIPTION/PURPOSE:
A wheelchair assessment is completed by the OT and/or PT to assist in improving a person’s mobility status. It is a comprehensive analysis of the person’s physical status as well as environmental issues which may interfere with their mobility.
OBJECTIVES/GOALS:


Obtain information regarding the person’s need and type of wheelchair system they may need to increase their independence.

Assure that this equipment will be appropriate in their environmental living situation, including home, transportation issues, etc.

Provide person with appropriate wheelchair system that will meet all their needs thus improving their mobility.

Follow up to assure that equipment adequately fits the person.


INDICATIONS:
Person with potential to improve their short or long distance mobility thus making them more independent within their environment.
CONTRAINDICATIONS:
Contraindications vary with diagnosis and equipment recommended.
PRECAUTIONS:
Assure that all safety issues have been met. Provide person with a safety belt to use when propelling. Provide with anti-tippers to assure safety with mobility over inclined terrain and ramps.
EQUIPMENT:


Appropriate wheelchair to stimulate mobility.

Tape measure.

Wheelchair evaluation form provided by manufacturer of wheelchair being ordered.
ASSESSMENTS:
Wheelchair order forms are provided by the manufacturers of durable medical equipment. These forms can be completed at the time of evaluation.

Wheelchair Prescription (cont.)


PROCEDURES:


A wheelchair must be prescribed by the M.D.

The wheelchair evaluation will be completed by all needed disciplines.

The person will be offered the opportunity to try various wheelchairs to assure appropriate recommendations.

All information will be gathered regarding the persons mobility needs, living situation, and transportation needs.

The M.D. will provide written orders following your recommendations.

All 3rd party documentation will be completed by the OT or PT and signed off by the physician for insurance coverage.

Equipment will be supplied to the person.

Follow up will be completed by the person or team that prescribed such equipment.


DOCUMENTATION:


Obtain a physician’s order for a wheelchair evaluation.

Complete the evaluation and document findings and recommendations.

Obtain a physician’s order for recommendations made.

Fit client with equipment and document follow up of equipment.




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