Therapy Care Plan Addendum

The Therapy Care Plan Addendum is used to for interim orders when nursing is providing case management and the plan of care needs to be updated between re-certification as required by the new home health conditions of participation.

       The certification start and end date are indicted in the top right-hand corner of the form. Therapists may add new, changed or dates for completed goals, as needed

       Frequency and duration may be changed as needed. Columns are provided to organize individual goals by number, the date the goal was started, changed or updated

       Therapist are prompted to write objective and measurable goals for both short and long-term therapy, the therapy interventions, the date the goal was met and the expected date of discharge

        A signature and date line is provided at the bottom of the form

       Suggested directions for use are included

       Size:  8 x 11

       Prints 2-sides different, head-to-head

       White paper, black ink

       5-hole punched top and side

       100 per pad