Clinic template
A Cliniko treatment note template for an occupational therapy initial assessment
This template covers activities of daily living, the home and community environment, and goals scored performance and satisfaction out of 10 per problem in the style of the Canadian Occupational Performance Measure. It differs from a physiotherapy assessment by starting from occupation and environment rather than a body region, and is built as a Cliniko treatment note template.
Last checked 25 Sep 2026 against the sources listed at the end of this page.
Free template ยท Cliniko
Treatment note: initial assessment: occupational therapy
The template: 20 fields
| Section | Field | Type | Notes |
|---|---|---|---|
| Referral and background | Referral source | Radio | Cliniko type: Multiple choice. Options: Self / GP (Medicare CDM) / NDIS / DVA / Aged care package / Workers compensation / Other. |
| Referral and background | Reason for referral | Paragraph | What the patient or referrer identifies as the problem. |
| Referral and background | Living situation and supports | Paragraph | Who the patient lives with, and any paid or informal supports already in place. |
| Occupational performance | Self care tasks (bathing, dressing, toileting, grooming) | Paragraph | Independence level and any difficulty for each task raised. |
| Occupational performance | Domestic and community tasks (meal prep, cleaning, shopping, transport) | Paragraph | |
| Occupational performance | Productivity and leisure roles | Paragraph | Work, study, caring roles or leisure activities the patient wants to maintain or resume. |
| Occupational performance | Cognitive factors affecting daily tasks | Paragraph | Memory, planning, safety awareness, where relevant to the referral. |
| Goals | Occupational performance problems identified | Paragraph | Up to five specific tasks the patient identifies as important and currently difficult, in their own words, following the Canadian Occupational Performance Measure structure. |
| Goals | Performance score per problem (1 to 10) | Text | Cliniko has no number type, so use Single line text, one score per problem listed above. |
| Goals | Satisfaction score per problem (1 to 10) | Text | Scored the same way as performance: 1 is not satisfied at all, 10 is extremely satisfied. |
| Goals | Priority problems for intervention | Paragraph | Which of the problems above the patient and therapist agree to work on first. |
| Environment | Home environment observations | Paragraph | Access, stairs, bathroom and kitchen layout, as relevant to the referral. A full room by room assessment belongs in the home modification template. |
| Environment | Community and transport access | Paragraph | |
| Environment | Current equipment or aids in use | Paragraph | |
| Assessment | Clinical impression | Paragraph | How the occupational performance and environment findings explain the difficulty raised at referral. |
| Assessment | Risk factors identified | Checkboxes | Options: Falls risk / Skin integrity / Carer strain / Social isolation / Cognitive safety risk / None identified. |
| Plan | Intervention plan | Paragraph | Therapy, equipment, home modification referral, or onward referral, matched to the priority problems above. |
| Plan | Review date and re-scoring plan | Text | When the COPM problems will be re-scored to check for change. |
| Consent | Informed consent | Checkboxes | Options: Assessment findings explained / Plan and options explained / Costs explained / Consent given to proceed. |
| Consent | Consent notes | Paragraph | Anything declined or any specific concern the patient raised. |
Build it in Cliniko
- Go to Settings > Treatment note templates as an Administrator, click Add template and name it Occupational therapy initial assessment.
- Add each section above with Add section, then set every question to one of Cliniko's six question types: Paragraph text, Single line text, Multiple choice, Checkboxes, Body chart or Date.
- Keep the occupational performance problems as a single Paragraph field listing all identified problems, then use two short Single line text fields for the performance and satisfaction scores, since Cliniko notes do not calculate an average automatically.
- Type the Multiple choice and Checkboxes options exactly as listed in the note column so referral source and risk factors stay consistent across the clinic.
- Assign the template to your occupational therapy initial consultation appointment type.
- Write one test note on a test patient scoring three sample problems, save it as a PDF, and check the performance and satisfaction scores print clearly next to each problem before the template goes live.
AHPRA: Occupational therapists are registered under the National Law and the Occupational Therapy Board of Australia applies the shared Code of conduct for registered health practitioners, which asks for accurate records that support informed consent and let another practitioner continue the patient's care.
Starting from occupation, not a body region
An occupational therapy assessment answers a different question to a physiotherapy one: not what is wrong with a joint or muscle, but what tasks the person can no longer do the way they want to, and why. This template is organised around self care, domestic and community tasks, and productivity and leisure roles, with the environment treated as a separate section rather than folded into a body chart or range of movement grid, because for OT the environment is often part of the problem, not just context around it.
Why the goals section scores performance and satisfaction separately
The goals section follows the structure of the Canadian Occupational Performance Measure: the patient names up to five tasks that matter to them and are currently difficult, then scores each one for performance and satisfaction separately, both out of 10. Scoring the two dimensions apart matters because a patient can perform a task adequately but still be dissatisfied with how they do it, or vice versa, and a single combined score would hide that. Re-scoring the same problems at review, rather than picking new ones, is what turns the initial assessment into an outcome measure rather than a one off list.
Environment here is a screen, not the full home visit
The environment section in this initial assessment is a screen: enough to flag access, stairs or layout issues that affect the goals raised, and to decide whether a dedicated home visit is needed. A full room by room assessment with measurements and photos, of the kind an NDIS home modification request needs, is built as its own template in this same cluster rather than repeated here, so the initial assessment stays focused on occupation and the home modification template stays focused on the physical environment.
Sources
- The Canadian Occupational Performance Measure scores each identified occupational performance problem for both performance and satisfaction on a scale of 1 to 10, where 1 is unable to perform or not satisfied at all and 10 is performed as well as before or extremely satisfied, and a change of two or more points is considered clinically important. COPM (Canadian Occupational Performance Measure), 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 and assignable to an appointment type. Cliniko Help, checked 25 Sep 2026.
- Treatment note templates can be exported as a .json file by an Administrator and imported into another Cliniko account, or built from an uploaded JPG, PNG, WEBP or PDF up to 5MB. 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 accurate, accessible records sufficient for another practitioner to continue care and to demonstrate informed consent. Occupational Therapy Board of Australia, checked 25 Sep 2026.