Physical Therapy Intake Form Template for Australia

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Physical Therapy Intake Form Template

"I need a Physical Therapy Intake Form Template for my sports physiotherapy clinic in Brisbane, compliant with Australian regulations, with additional sections for sports injury assessment and return-to-play protocols."

Document background

The Physical Therapy Intake Form Template is a standardized document used across Australian physiotherapy practices to gather essential patient information before commencing treatment. This document serves as the initial point of contact between the healthcare provider and patient, collecting crucial information about the patient's medical history, current condition, and consent for treatment. The template is designed to comply with Australian healthcare regulations, including the Privacy Act 1988, state-specific health records legislation, and professional practice standards set by the Physiotherapy Board of Australia. It includes sections for personal information, medical history, current symptoms, insurance details, and informed consent, ensuring comprehensive documentation for both clinical and legal purposes. The form is particularly important for risk management, proper patient care, and maintaining accurate healthcare records as required by Australian law.

Suggested Sections

1. Patient Personal Information: Basic demographic information including full name, date of birth, address, contact details, and emergency contact information

2. Insurance and Billing Information: Medicare details, private health insurance information, WorkCover or TAC claim details if applicable

3. Current Condition: Description of present condition, symptoms, pain levels, onset of symptoms, and current limitations

4. Medical History: Past medical conditions, surgeries, medications, allergies, and other relevant health information

5. Lifestyle and Occupational Information: Work duties, daily activities, exercise habits, and lifestyle factors affecting physical condition

6. Pain Assessment: Detailed pain diagram, pain scale, pain characteristics, and aggravating/relieving factors

7. Consent for Treatment: Informed consent for physical therapy treatment and acknowledgment of risks

8. Privacy Statement: Information about how patient data will be collected, used, and protected in accordance with the Privacy Act 1988

9. Financial Agreement: Payment terms, cancellation policy, and fee structure acknowledgment

Optional Sections

1. Sports Activity History: For practices focusing on sports rehabilitation - detailed information about sports participation and specific athletic goals

2. Pregnancy Information: For women's health physiotherapy - specific information related to pregnancy and post-partum conditions

3. Work Injury Details: For WorkCover cases - specific information about work-related injuries and employer details

4. Vehicle Accident Information: For TAC cases - specific information about transport accidents and claim details

5. Pediatric Development History: For pediatric patients - developmental milestones and specific pediatric health concerns

6. Previous Physical Therapy: Details of any previous physical therapy treatment and outcomes

Suggested Schedules

1. Pain Diagram: Visual diagram for patients to mark areas of pain or discomfort

2. Medical Screening Questionnaire: Detailed checklist of medical conditions and risk factors

3. Exercise History Form: Detailed record of current and past exercise routines

4. Functional Assessment Scale: Standardized assessment of functional capabilities and limitations

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Allied Health Services

Medical Practices

Sports Medicine

Rehabilitation Services

Occupational Health

Insurance

Workers Compensation

Sports and Recreation

Aged Care

Relevant Teams

Administration

Clinical Operations

Patient Services

Medical Records

Compliance

Legal

Front Desk

Quality Assurance

Risk Management

Relevant Roles

Physical Therapist

Physiotherapist

Practice Manager

Healthcare Administrator

Allied Health Professional

Sports Physiotherapist

Rehabilitation Specialist

Clinical Director

Compliance Officer

Medical Records Manager

Reception Coordinator

Patient Services Manager

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Authors

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