Plan of Care
The physical therapist establishes a plan of care and manages the needs of the patient/client based on
the evaluation, diagnosis, prognosis, goals, continuous assessment and outcomes of the planned interventions
for identified impairments, functional limitations, abilities and disabilities.
The physical therapist involves the student and others (parents, involved family, caregivers, other
related service providers, instructional staff, agency staff, community therapists, physicians, etc.) in the
planning, implementation, and assessment of the plan of care.
The physical therapist, in consultation with student, family and appropriate disciplines, plans from the
onset of service for exiting services taking into consideration achievement of anticipated goals and expected
outcomes, and provides for appropriate follow-up or referral.
The plan of care:
 Is based on the examination, evaluation, diagnosis, and prognosis.
 Identifies goals and outcomes.
 Describes the proposed interventions, including frequency and duration.
 Includes documentation that is dated and appropriately authenticated by the physical therapist who
established the plan of care.
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SAMPLE
School-Based Physical Therapy
Plan of Care (POC)
STUDENT NAME:
SCHOOL/TEACHER/GRADE:
IEP Dates:
START ____/_____/_________
END ____/_____/_________
POC Date: ____/_____/_________
Therapist:
Therapist’s contact:
Parent/Family:
Parent/Family contact info:
Precautions:
GOALS, FREQUENCY, DURATION, LOCATION – (see IEP)
STUDENT GOALS/INTERESTS:
INTERVENTION APPROACHES:




Health promotion/Self-determination
Skill acquisition
Environmental modification/Adaptation
Prevention
INTERVENTION TYPES:








One-On-One Intervention
Group
Whole Class
Consultation/Problem solving with team
Training for team
Environmental modification/equipment/adaptation
Program/Routine development and monitoring
Exploration/support of opportunities for participating in general education classes:
o _______________________________________________________________________________________
 Exploration/support of opportunities for participating in extracurricular activities:
o _______________________________________________________________________________________
 Exploration/support of opportunities for participating in community programs, work, other:
o _______________________________________________________________________________________
OUTCOME MEASURES:
 Attain IEP Goals
 Improve team and student performance/satisfaction
 Increased student competence and/or independence at school
 Prevention of related or further obstacles/difficulties
 Improved quality of life at school and/or other settings
 Increased participation at school
 Increased team capacity
TEAM DISCUSSION ON SUGGESTIONS FROM/FOR PARENT and TEACHERS:
TRANSITION PLAN/ISSUES FOR CONSIDERATION:
PLANNING FOR FUTURE EXIT FROM SCHOOL-BASED PT:
REFERRAL (e.g. community programs/resources, other disciplines):
PLANNED INTERVENTIONS/CLINICAL APPROACHES: (please describe specific interventions or
approaches)
 Mobility Transfers Safety Adaptation/Equipment Environmental modification Developmental
Motor control and coordination-

Neurodevelopmental –

Neuromotor and balance-
 Sensory motor  Therapeutic Exercise Manual therapy techniques Functional training to improve skills or independence with activities of daily living required at
school Pulmonary enhancement Pain management Play Community Access Work Skills-
PT: ________________________________________
Phone #: ______-______-____________
Email: __________________________________________________________________