Physical Therapy Initial Evaluation Checklist
Comprehensive physical therapy initial evaluation including subjective history, objective examination, assessment, and treatment planning.
- Industry: Healthcare
- Frequency: Initial evaluation
- Estimated Time: 45-60 minutes
- Role: Physical Therapist
- Total Items: 31
- Compliance: APTA Guide to Practice, CMS Documentation Requirements, State Practice Act
Subjective History
Patient-reported information
- Chief complaint documented?
- History of present condition?
- Prior level of function documented?
- Patient goals identified?
- Relevant medical history documented?
Objective Examination
Clinical findings
- Range of motion assessed?
- Strength assessed?
- Balance assessed?
- Gait/mobility assessed?
- Functional tests completed?
Assessment
Clinical impression
- Clinical impression documented?
- Rehabilitation potential assessed?
- Barriers to progress identified?
Plan of Care
Treatment planning
- Measurable goals established?
- Frequency and duration specified?
- Interventions planned?
- Discharge criteria identified?
Pre-Assessment Information
Initial assessment documentation and patient/facility identification
- Assessor Name / Credentials
- Assessment Date
- Department / Unit
- Assessment Type (Routine/Annual/Complaint)
- Previous assessment findings reviewed?
Infection Prevention & Control
Verify infection control practices per CDC and Joint Commission standards
- Hand hygiene compliance observed?
- Appropriate PPE available and properly used?
- Isolation precautions properly implemented?
- Sharps containers available and not overfilled?
- High-touch surfaces properly disinfected?
Patient Safety & Identification
Verify patient safety protocols and identification procedures
- Two patient identifiers used before procedures?
- Fall risk assessment completed?
- Call light within patient reach?
- Bed in lowest position with brakes locked?
Related Healthcare Checklists
- Occupational Therapy Initial Evaluation Checklist
- Speech-Language Pathology Evaluation Checklist
- Social Work Assessment Checklist
- Dietary/Nutrition Screening Assessment Checklist
- Respiratory Therapy Assessment Checklist
- Chaplain/Spiritual Care Assessment Checklist
- Wound Care Assessment & Documentation Checklist
- Pre-Operative Nursing Assessment Checklist
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Why Use This Physical Therapy Initial Evaluation Checklist?
This physical therapy initial evaluation checklist helps healthcare teams maintain compliance and operational excellence. Designed for physical therapist professionals, this checklist covers 31 critical inspection points across 7 sections. Recommended frequency: initial evaluation.
Ensures compliance with APTA Guide to Practice, CMS Documentation Requirements, State Practice Act. Regulatory-aligned for audit readiness and inspection documentation.
Frequently Asked Questions
What does the Physical Therapy Initial Evaluation Checklist cover?
This checklist covers 31 inspection items across 7 sections: Subjective History, Objective Examination, Assessment, Plan of Care, Pre-Assessment Information, Infection Prevention & Control, Patient Safety & Identification. It is designed for healthcare operations and compliance.
How often should this checklist be completed?
This checklist should be completed initial evaluation. Each completion takes approximately 45-60 minutes.
Who should use this Physical Therapy Initial Evaluation Checklist?
This checklist is designed for Physical Therapist professionals in the healthcare industry. It can be used for self-assessments, team audits, and regulatory compliance documentation.
Can I download this checklist as a PDF?
Yes, this checklist is available as a free PDF download. You can also use it digitally in the POPProbe mobile app for real-time data capture, photo documentation, and automatic reporting.