Discharge Summary (Athletic Therapy Rehabilitation)

Athletic Therapy Rehabilitation Discharge Summary

Date of Discharge: [Discharge date]

Patient Name: [Full name]

DOB: [Date of birth]

MRN: [Identifier]

Primary Diagnosis/Region: [Diagnosis, region, and laterality]

Episode Dates: [Start date] – [End date]

Onset or Surgery Date: [Date] (Omit line if not applicable)

Total Visits Completed: [Number of attended visits]

Referring Clinician: [Name, credentials, organization] (Omit line if not applicable)

Episode Summary

[Brief episode summary] (3–5 sentences stating: primary rehab diagnosis; mechanism of injury or precipitating event; surgical procedure and date if applicable; athlete's sport/position or work role if relevant to goals; key precautions that guided progression. Write so the note stands alone without requiring access to prior documentation.)

Course of Care

Attendance: [Planned visits] planned, [completed visits] completed. [Notable gaps and reasons if applicable]

Interventions: [High-level summary of intervention categories delivered, such as therapeutic exercise, neuromuscular control and balance training, mobility work, manual therapy, sport-specific conditioning, load management education, taping or bracing] (Do not reproduce daily notes; summarize at the category level with progression highlights only if explicitly documented.)

Equipment/Devices Issued: [Item, wear schedule, return/stop criteria] (Omit line if none issued)

Outcomes at Discharge

Patient-Reported Status

• Pain: [Current level, scale used, pattern/irritability]
• Functional tolerance: [Current participation capacity relevant to goals]
• Confidence/readiness: [Self-efficacy and perceived readiness statements]
• Patient-stated goal status: [Which goals patient believes were met]

Objective Measures (Include only measures relevant to condition and goals. Ensure at least one objective anchor supports each major discharge claim. Remove unused rows; add rows as needed.)

Measure/Domain	Baseline (date)	Discharge (date)	Notes/Criteria
[ROM - joint/plane]	[Baseline values]	[Discharge values]	[Norms or side-to-side comparison]
[Strength - method/units]	[Baseline values]	[Discharge values]	[Limb symmetry index/targets]
[Balance/neuromotor - test name]	[Baseline score]	[Discharge score]	[Cutoffs or qualitative notes]
[Functional performance - test name]	[Baseline performance]	[Discharge performance]	[Clearance criteria]
[Symptom response to activity]	[Baseline response]	[Discharge response]	[Tolerance thresholds]
[PROM - instrument name]	[Baseline score]	[Discharge score]	[MCID if applicable]

Goal Status (Mark status as [Met / Partially Met / Not Met / Discontinued]. Met status requires explicit objective evidence.)

Goal	Status	Evidence/Comments
[STG/LTG]: [Goal statement]	[Met / Partially Met / Not Met / Discontinued]	[Objective measure or observable function supporting status; barriers if relevant]
[STG/LTG]: [Goal statement]	[Met / Partially Met / Not Met / Discontinued]	[Objective measure or observable function supporting status; barriers if relevant]

Remaining Deficits: [Persistent impairments, functional limitations, participation restrictions, and modifiable risk factors] (Use "None identified" if not applicable)

Discharge Data Unavailable: [Reason: non-attendance / authorization ended / seasonal constraint / other]. Last assessed [date]. [Summary of last known status and tolerance. Pending measures not completed.] (Only include this block if discharge occurred without final testing; otherwise omit entirely)

Discharge Disposition

Reason for discharge: [Goals met or maximum benefit achieved / Transition to independent self-management / Transfer of care to (specify recipient) / Plateau (explain) / Patient-requested discharge / Non-attendance or lost to follow-up / Insurance, authorization, or seasonal constraint]

Clinical rationale: [Explanation of why further skilled rehabilitation is not required, or note if continued rehab is recommended but did not occur and why]

Return-to-Sport / Return-to-Work Status

(Only include this section when participation status is a key outcome; omit entirely if not applicable)

Role: [Sport and level] or [Work role]

Current participation stage: [Modified training / Full participation with restrictions / Return to performance / other stage]

Clearance source: [Rehab provider recommendation / Medical clearance by (physician name, date)] (Do not imply physician clearance if it did not occur)

Objective criteria supporting status: [List criteria with referenced tests/measures from Outcomes table]

Current restrictions/accommodations: [Contact restrictions, time/volume limits, protective equipment requirements, lifting/task limits]

Risks, benefits, and warning signs reviewed with patient and relevant stakeholders.

Discharge Instructions

Home Exercise Program:

• Components: [Key exercises or categories]
• Dosing: [Sets, reps, hold time, frequency per week]
• Intensity: [Target exertion or symptom threshold]
• Progression: [Criteria to advance; how to regress if symptoms flare]

Activity Guidance:

• Allowed now: [Activities permitted]
• Avoid temporarily: [Activities to avoid and rationale]
• Warm-up/recovery: [Recommendations]

Symptom Monitoring:

• Expected response: [Normal post-exercise response]
• Concerning symptoms: [Stop activity and seek care thresholds]
• Red flags requiring urgent evaluation: [Urgent warning signs]

Equipment Care: [Wear schedule, care instructions, stop/return criteria] (Omit if no equipment issued)

Follow-up: [Provider, timeframe, purpose]. Return PRN for [recurrent swelling / instability / pain above threshold / other criteria].

Patient verbalized understanding of HEP dosing, precautions, and follow-up plan.

Signature

Clinician: [Name, credentials] — [Date]

Supervising/Cosigning Clinician: [Name, credentials] — [Date] (Include only if required by setting)