Clinic template
A Cliniko treatment note template for an OT home modification assessment
This template walks a room by room home assessment (entry, bathroom, kitchen, bedroom) with a measurement field and a photo prompt in every room, plus the functional need each modification addresses, so the note doubles as the working file behind an NDIS home modification request. It is built as a Cliniko treatment note template, distinct from the general OT initial assessment in this cluster.
Last checked 25 Sep 2026 against the sources listed at the end of this page.
Free template ยท Cliniko
Treatment note: home modification assessment: occupational therapy
The template: 20 fields
| Section | Field | Type | Notes |
|---|---|---|---|
| Assessment context | Funding pathway | Radio | Cliniko type: Multiple choice. Options: NDIS / Home Care Package / DVA / Private. The category of modification and level of detail expected differs by pathway. |
| Assessment context | Reason for the home visit | Paragraph | The functional problem prompting the assessment, and who raised it. |
| Assessment context | People present at the visit | Text | Patient, carer, builder or support coordinator, as relevant. |
| Entry and access | Entry path measurements | Text | Path width, step height and number of steps, ramp gradient if one exists. |
| Entry and access | Entry photos taken | Checkboxes | Options: Approach path / Front step or ramp / Door threshold / Door width. Tick each photo actually taken. |
| Entry and access | Functional difficulty at entry | Paragraph | What the patient cannot do safely or independently at the entry today. |
| Bathroom | Bathroom measurements | Text | Doorway width, clear floor space, shower recess dimensions, toilet height and clearance. |
| Bathroom | Bathroom photos taken | Checkboxes | Options: Doorway / Shower or bath / Toilet / Vanity and clear floor space. |
| Bathroom | Functional difficulty in the bathroom | Paragraph | Transfers, showering, toileting difficulty observed or reported. |
| Kitchen | Kitchen measurements | Text | Bench height, turning circle, doorway width if relevant to the referral. |
| Kitchen | Kitchen photos taken | Checkboxes | Options: Bench and cooktop / Sink / Storage reach / Doorway. |
| Kitchen | Functional difficulty in the kitchen | Paragraph | |
| Bedroom and other rooms | Bedroom measurements | Text | Bed height, turning space, doorway width. |
| Bedroom and other rooms | Other rooms assessed | Paragraph | Laundry, living area or garage, only where relevant to the referral. |
| Recommendations | Recommended modifications | Paragraph | Each modification named against the room and the functional difficulty it addresses, for example step ramp at entry to remove the fall risk on the front step. |
| Recommendations | Modification category | Radio | Options: Minor / Category A / Category B / Complex, matched to the funding pathway's own categories. |
| Recommendations | Alternatives considered and why rejected | Paragraph | Shows the recommendation was chosen for value for money, which a funding body request needs to demonstrate. |
| Recommendations | Trial or interim equipment while modification is arranged | Paragraph | |
| Consent | Informed consent | Checkboxes | Options: Purpose of the visit explained / Photos and measurements consented to / Report will be shared with funding body / Consent given. |
| Sign off | Report to be prepared for | Text | NDIS planner, support coordinator, builder or aged care provider, as relevant. |
Build it in Cliniko
- Go to Settings > Treatment note templates as an Administrator, click Add template and name it OT home modification assessment.
- Add one section per room as listed above, using Add section, and give each room its own measurement field, a Checkboxes field for the photos actually taken, and a Paragraph field for the functional difficulty observed there.
- Cliniko's Checkboxes and Multiple choice options need to be typed out exactly as listed in the note column so the modification category and funding pathway stay consistent for reporting.
- Photos themselves are attached to the patient file separately in Cliniko rather than embedded in the treatment note question, so use the Checkboxes field as a record that a photo was taken, and file the actual images against the patient at the same time.
- Assign the template to a Home visit or Home modification assessment appointment type if you have one, or apply it manually after the visit.
- Run one test note against a test patient covering at least two rooms, save it as a PDF, and check the measurement and photo checklist fields print clearly enough to hand to a builder or funding body alongside the actual photos.
AHPRA: The Occupational Therapy Board of Australia applies the shared Code of conduct for registered health practitioners, which asks for records detailed enough for another practitioner, or in this case a funding body or builder, to understand and act on the assessment without the original therapist present.
Built to hand off, not just to file
A home modification assessment is read by people who were never in the room: an NDIS planner deciding whether to fund the work, a builder quoting it, or a support coordinator checking progress. This template treats the note as a working document for those readers, not only a clinical record, which is why every room carries its own measurements and a checklist of the photos taken rather than a single free text description of the whole house.
Why every room repeats the same three fields
Measurements, a photo checklist and functional difficulty are repeated identically in every room so the note reads the same way whichever room a reader jumps to, and so nothing gets assessed with more rigour than the room next to it just because it came up first in conversation. The functional difficulty field ties each room back to what the patient actually cannot do, which is what turns a list of measurements into a case for funding rather than a floor plan.
Alternatives considered is the field NDIS requests are checked against
The recommendations section asks what alternatives were considered and why they were rejected, because a home modification request has to show the recommended option represents value for money against the person's needs, not just that it would work. Recording that reasoning at the time of the visit, while the room and the alternatives are fresh, is easier and more defensible than reconstructing it later for a request or a review.
The modification category field also matters beyond record keeping. NDIS treats minor modifications differently from Category B and complex work, and only a specialised home modification assessor can complete the assessment for the more involved categories, so recording the category at the time of the visit is what tells a practice manager whether this particular assessment needed that extra qualification in the first place. It also sets expectations early with the participant about how much documentation and lead time their request is likely to need.
Sources
- NDIS home modification assessments must be completed by an occupational therapist or other suitably qualified allied health professional, with minor modifications assessable by any qualified occupational therapist while Category B and complex modifications require a specialised home modification assessor with experience in functional capacity assessment and accessibility standards. NDIS (National Disability Insurance Agency), checked 25 Sep 2026.
- NDIS home modification funding requests are expected to show the recommended solution represents value for money and is suitable for the participant's anticipated long term needs, since further modifications to the same premises are unlikely to be funded except where the participant's needs change significantly. NDIS (National Disability Insurance Agency), checked 25 Sep 2026.
- Cliniko treatment note templates support six question types (Paragraph text, Single line text, Multiple choice, Checkboxes, Body charts and Date), built under Settings > Treatment note templates. Cliniko Help, checked 25 Sep 2026.
- The Occupational Therapy Board of Australia applies the shared Code of conduct for registered health practitioners published by Ahpra and the National Boards, which asks for records that are accurate and accessible to others involved in a patient's care. Occupational Therapy Board of Australia, checked 25 Sep 2026.