Daily-Living & Accessibility Intake
Editable daily-living & accessibility intake template with online review plus licensed PDF, Word, and print tools after purchase.
For Occupational Therapy Assistants · Intake Form · CA$5
Capture routines, participation goals, access barriers, relevant health information shared, equipment, supports, and contacts.
Included editable fields
- Occupational Therapy Assistant
- Client / Customer / Authorized Party
- Service Location
- Supervising Professional
- Approved OT Plan
- Daily-Living Activity
- Adaptive Equipment
- Safety / Access Restrictions
- Intake Date
- Service / Job Location
- Job / Service Type
- Scope / Purpose
- Client Instructions / Prior History
- Client Responsibilities
- Pre-Start Confirmations
- Known Risks & Disclosures
- Limitations & Exclusions
- Information Authorization / Acknowledgement
- Intake Checklist
- Follow-Up / Outcome
- Record Timestamp