Horticultural Therapy Co-Treatment Note (OT/PT/SLP Collaboration)

Date of Service: [Date]

Setting/Site: [Setting or site]

Total Treatment Time (minutes): [Total minutes]

Timed Code Treatment Minutes: [Timed minutes]

Service Delivery Mode: [Individual / Group (size: __) / Co-Treatment / Co-Led Group]

Disciplines Present & Roles: [Disciplines and roles]

Ordering Provider: [Ordering provider name and credentials]

Co-Treatment/Group Rationale

[Clinical justification for concurrent treatment; distinct goals each discipline addressed; why separate sessions would be less effective or unsafe. For groups, include group purpose and why group context benefits this participant.] (2-4 sentences. Omit this section entirely for individual sessions.)

Subjective

[Participant or caregiver report of readiness, fatigue, pain, mood, and motivation relevant to today's session; include direct quotes when clinically meaningful.] (2-4 sentences. State limitation if participant cannot report and no collateral is available.)

Objective

Horticultural Activity: [Gardening task(s) used as therapeutic medium; task grading and modifications; adaptive equipment; assistance, guarding, and cueing level; participation metrics such as repetitions, duration, or steps completed.]

(For co-treatment, document each discipline's skilled contribution separately below. Include only disciplines that provided skilled intervention. For single-discipline sessions, omit discipline subheadings and document skilled intervention inline.)

OT Skilled Intervention: [Goals targeted; interventions delivered; objective performance data; participant response.] (Include only if OT provided skilled intervention.)

PT Skilled Intervention: [Goals targeted; interventions delivered; objective performance data; participant response.] (Include only if PT provided skilled intervention.)

SLP Skilled Intervention: [Goals targeted; interventions delivered; objective performance data; participant response.] (Include only if SLP provided skilled intervention.)

Education/Training: [Learner(s); topic(s) taught; verification of understanding.] (Include only if education was provided.)

Assessment

[Interpretation of today's performance with objective evidence; progress toward goals; clinical reasoning requiring skilled judgment; barriers and facilitators. For co-treatment, state whether simultaneous delivery improved outcomes and whether co-treatment remains indicated.] (Short paragraph or 3-5 concise bullets.)

Plan

• [Next session focus and planned progressions or modifications]
• [Service delivery mode next session if changing]
• [Care coordination, referrals, or discharge planning as applicable]

Signatures

[Clinician signature, credentials, date/time for each discipline that provided skilled intervention]

[Student or assistant supervision and attestation, if applicable]