Inpatient Rehabilitation Facility Interdisciplinary Team Conference Note

Date/Time: [conference date and start time]

IRF Day: [number] (Admission: [date])

Primary Diagnosis/Impairment Category: [primary diagnosis and impairment category]

Attending Physician: [name, credentials]

Conference Participants

Meeting Format: [in-person / hybrid / remote]

Team Members Present: [List each attendee as: Name, Credentials (Role). Required: rehabilitation physician (leader), rehabilitation RN, case manager or social worker, and therapist(s) from each discipline actively treating. Include other disciplines only if actively treating.]

Patient Participation: [participated / did not participate] (If not present, briefly state reason when known.)

Caregiver/Family Participation: [names and relationships, or "none"] (Note preferences expressed if any.)

Clinical Status and Progress

Key Events Since Last Conference: [brief summary of new diagnoses, complications, falls, procedures, pain issues, or changes in precautions affecting rehabilitation participation]

Current Rehabilitation Tolerance: [one-line summary of tolerance and any limiting factors]

Progress Toward Goals: [For each of the top 3–6 interdisciplinary goals, document: the functional goal, current status with level of assist, trajectory (improving/plateau/regressing), and primary barriers. Organize by functional domain such as mobility, ADLs, cognition, or swallowing rather than by discipline. Include discipline-specific observations only when they directly inform progress or barriers. If objective measures are pending, state this explicitly rather than estimating.]

Discharge Plan

Target Date: [date] (Note if changed this week with brief rationale.)

Destination: [primary plan; contingency if applicable]

Anticipated Assistance Needs: [expected levels for transfers, mobility, stairs, toileting, medications, and supervision]

Equipment/Home Modifications: [DME items and modifications with status: recommended / ordered / delivered]

Post-Discharge Services: [home health, outpatient therapy, follow-up appointments with timeframes]

Caregiver Training: [trainee name/relationship; skills completed; skills pending before discharge]

(If destination undecided, document what must occur to finalize the decision.)

Plan Updates and Action Items

Decisions Made This Conference: [goal revisions, therapy emphasis changes, new precautions, discharge updates, or family meeting plans — include brief rationale for significant changes]

Action Items:

• [task description] — Owner: [name or role] — Due: [date or timeframe]

Physician Concurrence

[Physician name, credentials] reviewed the team's findings and [concurs with / modifies] the interdisciplinary plan. (If modifications were made, summarize the final decision and rationale. This statement serves as required authentication of conference decisions.)