Client: Physical Therapist:

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Date of birth: Year Gender:Medical diagnosis (Dx): Month DayDate of Dx: Year Month Day Date of intake: Year Month Day

PT Client Management Canvas » Initial Data

Interview & informal observation

Guidelines, evidence & remarks

Client: Physical Therapist:

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ter to Creative Commons, 444 Castro Street, Suite 900, Mountain View, California, 94041, USA.

PT Client Management Canvas » Problem Tracking

Problem list of activity limitation & participation restriction �H[LVWLQJ��DQWLFLSDWHG��SDWLHQW���QRQ�SDWLHQW�LGHQWL¿HG� Date

Baseline

Functional measures Date

Goal

Functional measures Date

Progress / discharge

Functional measures

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Problem # Hypotheses of causative impairments & other factors Date Testing & predictive criteria Date Testing & predictive criteria Date Testing & predictive criteria1 2 3 4 5 6

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Client: Physical Therapist:

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ter to Creative Commons, 444 Castro Street, Suite 900, Mountain View, California, 94041, USA.

PT Client Management Canvas » Examination

Tests & measurements Findings Indications

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Tests & measurements Findings Indications

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Client: Physical Therapist:

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ter to Creative Commons, 444 Castro Street, Suite 900, Mountain View, California, 94041, USA.

PT Client Management Canvas » Intervention

Problem #’s Hypotheses #’s Strategy

Tactic (description, intensity, duration & frequency) Implemeter Progression & Remarks