Occupational Therapy Progress Status

•Treatment Diagnosis and Onset Date

•Start of Care Date

•Discharge/Outcome/Setting/Long Term Goal

•Frequency/Duration

•OT Goals

•Precautions and Barriers

•Treatment Modalities with CPT Codes

•Initial Evaluation Status + 5 Update Status Fields

•OT/COTA Conference

•Physician Orders

Reverse side of form provides space for additional comments and progress notes.