Patient Leisure/Home Program Instructions (Recreational Therapy)

Recreational Therapy Home & Community Activity Plan

Patient Name: [Patient name]

Date: [Date]

Setting/Visit Type: [inpatient rehab discharge / outpatient / home health]

Recreational Therapist: [Clinician name, credentials]

Questions? Contact: [Phone number or patient portal instructions]

[Brief opening statement connecting this plan to what matters to the patient] (Write 1–2 short sentences in plain language using "you" phrasing. Explain that this plan supports safe participation in meaningful activities at home and in the community.)

Your Goals

(Only include this section if the patient stated goals during the session; otherwise omit entirely. Use the patient's own words when possible.)

• [Patient-stated goal 1] (Use quotation marks if using the patient's exact words.)
• [Patient-stated goal 2] (Only include if provided.)
• [Patient-stated goal 3] (Only include if provided.)

Safety First

• Supervision: [Supervision needs for activities] (State who should be present and when. Omit if not discussed.)
• Assistive devices: [Devices or supports to use during activities] (Omit if not applicable.)
• Medical precautions: [Activity precautions from the care team] (If specific precautions were not communicated, write: "Follow your medical team's activity precautions. Ask your nurse or doctor before advancing activity if you're unsure.")
• Stop and contact your care team if: [Patient-specific stop-activity triggers]
• Emergency: Call 911 for emergencies. (If behavioral health crisis planning is relevant, add: "If you feel unsafe or might hurt yourself, call or text 988.")

Your Activity Plan

(Present recommended activities tailored to the patient's goals. Group by goal or activity type. Use short sentences, plain language, and "you" phrasing.)

[Goal area or activity type]: [Related patient goal or activity focus]

• Activity: [Name of activity]
• What to do and why: [Simple steps and how this helps your goal]
• How often and how long: [Frequency and duration]
• Make it easier: [Ways to reduce challenge]
• Make it harder: [Ways to progress safely]
• Equipment or support needed: [Items or assistance required] (Omit if none needed.)

(Repeat for each recommended activity. Create additional goal sections as needed.)

Pacing & Progression

(Include only if pacing or progression was discussed; otherwise omit entirely.)

• Start here: [Starting baseline for minutes, distance, reps, or events per week]
• Progress when: [Criteria to increase time or challenge]
• How to progress: [Specific step-ups; keep increases small and steady]
• If you miss days or have a flare-up: [How to scale back and restart safely]

Coping Strategies

(Include only if strategies for stress, mood, pain, or adjustment were taught; otherwise omit entirely.)

• [Strategy name]: [2–4 simple steps the patient can follow independently]

Community Resources

(Include only if specific resources were reviewed with the patient; otherwise omit entirely.)

• [Resource name]: [What it offers] — [Phone/email/website]. [Accessibility or cost notes if relevant.]

Next Steps

• Track: [1–2 simple measures such as minutes of activity or enjoyment rating 0–10] (Omit if tracking not discussed.)
• Follow-up: [Next appointment date/time or instructions to schedule]
• Update this plan if: New symptoms, falls, changes in precautions, hospital visits, or sustained improvement.

For Chart Documentation Only

(Do not include on patient copy.)

• Education provided: [Topics covered] to [patient / caregiver / both] via [verbal / written / demonstration].
• Teach-back: [performed—understood / performed—partial understanding / performed—needs reinforcement / not performed].
• Communication supports: [interpreter / translated materials / large print / none needed].
• Patient copy provided: [Yes / No].
• Signature: [Clinician name, credentials, date/time] (Include supervising clinician if applicable. If updating a prior plan, note date of prior version and key changes.)