Patient Progress Evaluation Form

[YOUR COMPANY NAME]

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Date: [Date]

Name:

Age:

Gender:

Evaluation Period:

Introduction

This is used to monitor the progress of patients in our acute care facility. It is a vital tool for our therapists to track improvements or setbacks and adjust interventions accordingly.

Overview

The evaluation is to be filled out by the patient's primary therapist. The therapist will assess the patient's progress in line with the criteria laid out below.

Criteria and Metrics

This evaluation will be based on the following criteria: Cognitive Functioning, Emotional Stability, Physical Well-being, Occupational Performance, and Quality of Social Interactions. Each category will be assessed on a scale of 1-5, with 1 being the lowest (needs improvement) and 5 being the highest (excellent).

Rating scale:

• (1) Poor quality

• (2) Below average quality

• (3) Average quality

• (4) Above average quality

• (5) Excellent quality

Evaluation Criteria	Description	Rating (1-5)
Cognitive Functioning	Assess overall cognitive skills including problem-solving, decision-making, and memory.
Emotional Stability	Evaluation of the patient's emotional well-being, including their ability to handle stressors.
Physical Well-being	Assessment of the patient's physical condition including mobility, overall health, and pain levels.
Occupational Performance	Evaluation of the patient's ability to perform daily tasks independently.
Quality of Social Interactions	Assessment of the patient's ability to interact and communicate effectively with others.

Additional Comments and Notes

If you possess any comments or annotations pertaining to the evaluation, kindly append them to the designated comment box.

Comments/Notes

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