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Home visit note template

Who was there, the home and its hazards, consent, treatment and equipment, for physios on the road.

How to use it: Treatment Notes on the Road Between Home Visits

The visit

  1. Who was present Short answer
  2. Consent for treatment confirmed Tick box
  3. Home environment and hazards Written answer
  4. How they have been since the last visit Written answer
  5. Pain today (0–10) Scale 0 to 10

Treatment

  1. Treatment today Written answer
  2. Equipment used or recommended Written answer
  3. Advice given to family or carers Written answer
  4. Plan and next visit Written answer
  5. Safety concern to follow up Tick box

A starting point, not clinical advice. Check that it fits your patients, your practice and the rules where you work before you use it.