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This document is used for outpatient physical therapy evaluations to assess patient conditions, mobility, and equipment needs.
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How to fill out Physical Therapy Outpatient Evaluation

01
Gather all necessary personal and medical information.
02
Complete the patient's demographics section (name, age, etc.).
03
Document the patient's medical history including previous treatments and surgeries.
04
Include any current medications being taken by the patient.
05
List the specific reason for referral to physical therapy.
06
Describe the patient's symptoms and any impairments.
07
Perform and document a physical examination.
08
Set measurable goals for the patient's therapy.
09
Outline the recommended physical therapy interventions.
10
Review and sign the evaluation with the therapist's credentials.

Who needs Physical Therapy Outpatient Evaluation?

01
Individuals recovering from surgery or injury.
02
Patients with chronic pain or movement disorders.
03
People needing rehabilitation after an accident.
04
Athletes looking to improve performance or recover from sports-related injuries.
05
Elderly individuals experiencing mobility issues or falls.
06
Those with neurological conditions such as stroke or Parkinson's disease.
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Your physical therapist will likely ask you to perform various exercises and stretches, so you'll want to wear clothes that don't restrict your range of motion. Athletic wear such as t-shirts, tank tops, shorts, or yoga pants are excellent choices. Avoid jeans, dress clothes, or anything too tight or constricting.
Clothing to Avoid Wearing to Physical Therapy There are some types of clothing that you should not wear to physical therapy, such as: Tight fitting clothes that restrict your movement. Dress shoes, sandals, flip flops, high heels, etc. Business attire.
Before Your Visit Make a list of any questions you have and want to ask your physical therapist. Write down any symptoms you've been having and for how long. Write down key information about your medical history, even if it seems unrelated. Ask a family member or trusted friend to go with you to your appointment.
PT Evaluation CPT Codes 97161Physical therapy evaluation: low complexity 97162 Physical therapy evaluation: moderate complexity 97163 Physical therapy evaluation: high complexity
Your physical therapist will likely ask you to perform various exercises and stretches, so you'll want to wear clothes that don't restrict your range of motion. Athletic wear such as t-shirts, tank tops, shorts, or yoga pants are excellent choices.
A complete PT evaluation starts with a clinical examination comprising the patient history, systems review, and objective data collection. Then, the PT communicates their findings in an evaluation followed by a prescribed plan of care (POC).

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Physical Therapy Outpatient Evaluation is an assessment conducted by a licensed physical therapist to evaluate a patient's physical condition, identify impairments, and develop a treatment plan for outpatient services.
Licensed physical therapists are required to file Physical Therapy Outpatient Evaluations as part of the patient intake process for outpatient services.
To fill out a Physical Therapy Outpatient Evaluation, the therapist should gather patient information, document medical history, perform necessary physical assessments, and enter findings and treatment goals in the evaluation form.
The purpose of Physical Therapy Outpatient Evaluation is to assess a patient's physical function, diagnose issues, set therapy goals, and create a tailored treatment plan for rehabilitation.
The information that must be reported on Physical Therapy Outpatient Evaluation includes patient demographics, medical history, current physical condition, assessment findings, and recommended treatment plans.
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