Clinical Logbook: Doctor of Physical Therapy

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CLINICAL LOGBOOK

DOCTOR OF PHYSICAL
THERAPY
DPT 7TH SEMESTER
COLLEGE OF PHYSICAL THERAPY
Assessment form
College of physical therapy GCUF
Department of physical therapy & rehabilitation
Surriya Majeed trust hospital

Name: S/O:
Age: Gender:
Marital status: Language:
Occupation: Address:
Mode of admission: Date of admission:

Medical Diagnosis:

Physical diagnosis:

History of present illness:


Past medical history:

Family history:

Objective evaluation:
ADL deficiencies:
Posture:
 Lying
 Sitting
 Standing

Pain:
 Onset
 Nature
 Radiating
 Aggravating factor
 Relieving factor
 Severity (NRS)
 Associated symptoms

Inspection:
Swelling:
Arrhythmia:
Joint deformity:

Muscle wasting:

Palpation:
Temperature:
Tenderness:
Edema:
Inflammatory sign:
Muscle wasting:
Contractures:

Examination:
Range of movement
Active:
Passive:
Muscle girth:
Limb length:
Differential test:
Gait assessment

MMT:

Neurological tests:
 Dermatomes
 Myotomes
 Reflexes
Lab test:
 Blood test
 X-Ray
 CT scan & MRI
Management
Short term goals:



Long term goals:



Intervention:
Manual therapy:
1.
2.
3.
Exercise therapy
1.
2.
Electrotherapy:
1.
2.
3.
Home plan:

Treatment outcome at end of session:

Name of student:
Roll no:
Program:
Signature of student: -------------------------------

----------------------------------
Supervisor

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