Occupational Therapy Hand Therapy Medical History Form
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Occupational Therapy Hand Therapy Medical History Form
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This specialized medical history form is tailored for certified hand therapists (CHTs) and occupational therapy practices focusing on upper extremity rehabilitation. It collects essential information about previous hand injuries, surgeries, nerve conditions, grip strength issues, and fine motor limitations that impact daily activities and occupational performance. The form includes detailed questions about dominant hand use, repetitive strain patterns, and work-related hand tasks.
Designed for hand therapy clinics, orthopedic occupational therapy practices, sports medicine centers with hand specialty programs, post-surgical hand rehabilitation facilities, and industrial therapy programs. The form streamlines intake by capturing bilateral hand function comparison, scarring or edema history, splinting experience, temperature sensitivity, and activity-specific limitations that inform evidence-based hand therapy interventions and customized exercise protocols.
What's included
- Dominant hand and bilateral function assessment
- Previous hand injuries and surgeries
- Nerve injury or carpal tunnel history
- Grip strength and fine motor limitations
- Work-related repetitive tasks
- Splinting and casting history
- Edema and scar tissue patterns
- Temperature sensitivity and circulation issues
- Activity-specific functional restrictions
- Goals for hand therapy treatment
Who uses this template
- Certified Hand Therapy Clinics
- Orthopedic Occupational Therapy Practices
- Sports Medicine Hand Rehabilitation Centers
- Post-Surgical Hand Therapy Programs
- Industrial Rehabilitation Facilities
All form fields
8 fields across 3 pages. Customize any field after signing up.
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