Yoga Therapy Re-evaluation/Progress Report

Yoga Therapy Re-evaluation / Progress Report

Patient: [name]

Date of Report: [date]

Reporting Period: [start date] to [end date]

Provider: [name, credentials]

Setting: [outpatient / telehealth / community]

Visits This Interval: [completed] of [scheduled]

Referral Source: [referral source, if applicable]

Reason for Report

[Trigger for report: scheduled progress interval / material clinical change / plateau / new precautions / pre-discharge summary / re-evaluation due to failure to respond or new findings] (If functioning as a re-evaluation rather than routine progress report, state what new tests or measures were performed and why additional reassessment was warranted.)

Subjective

[Summary of patient-reported status across the interval, including symptom changes, functional tolerance shifts, and response to yoga therapy] (Include adherence details covering attendance, home practice frequency, and barriers encountered. Note any interval medical or contextual updates affecting care such as new diagnoses, medications, hospitalizations, or provider restrictions. Use brief direct quotes only for meaningful patient-stated goals or functional changes.)

Objective

Measure	Baseline	Prior Report	Current	Interpretation
[measure name]	[baseline value / date]	[prior value / date]	[current value / date]	[brief interpretation]
[measure name]	[baseline value / date]	[prior value / date]	[current value / date]	[brief interpretation]
[measure name]	[baseline value / date]	[prior value / date]	[current value / not repeated]	[interpretation or reason not repeated]

(Use validated outcome measures when available. Include only measures directly relevant to the episode focus. If a measure was not repeated, indicate this with rationale.)

Functional Findings & Practice Tolerance: [observable changes in movement quality, breathing mechanics, positional tolerance, assistance level, and modifications required] (Summarize briefly; do not enumerate every possible finding.)

Assessment

[Synthesis of overall response to yoga therapy anchored to objective data] (State whether progress aligns with expected trajectory and identify factors affecting progress such as comorbidities, psychosocial stressors, or adherence barriers.)

Updated Problem List: [prioritized list of impairments, functional limitations, and participation restrictions relevant to yoga therapy goals]

Rationale for Continued Skilled Care: [why skilled clinical reasoning, monitoring, or tailoring is still required; why independent unsupervised practice would not be safe or effective at this time] (Include when documentation supports reimbursement.)

Goal Status

Goal	Baseline	Current Status	Status
[goal statement with target and timeframe]	[baseline metric]	[current metric; completion date if met]	[Met / Partially Met / Not Met / Revised / Discontinued]
[goal statement with target and timeframe]	[baseline metric]	[current metric; completion date if met]	[Met / Partially Met / Not Met / Revised / Discontinued]
[goal statement with target and timeframe]	[baseline metric]	[current metric; completion date if met]	[Met / Partially Met / Not Met / Revised / Discontinued]

(Retain met goals with completion date. For goals not met, briefly note barriers. Indicate which goals continue unchanged, are revised, or replaced.)

Plan

• Frequency & Duration: [visits per week] for [duration in weeks]
• Primary Focus Areas: [focus areas linked to problem list]
• Planned Progressions or Regressions: [specific changes with rationale tied to objective findings]
• Home Practice Prescription: [techniques, dose targets, safety cues, self-monitoring instructions]
• Discharge/Transition Criteria: [objective thresholds for discharge to self-management; criteria for escalation or referral]
• Coordination: [communication with referring clinician or interdisciplinary team, if applicable]

Next Progress Report Due: [date or visit number]

Provider Signature: [signature, credentials, date]