AI Scribe for Occupational Therapy: ADL Goals, Interventions, and Progress Notes
Occupational therapy notes emphasize function in context — ADLs, IADLs, cognition, sensory processing, workplace and school participation — not diagnosis lists alone.
An AI scribe for occupational therapy should structure goal-oriented documentation from session dictation.
OT documentation focus
- Patient/caregiver report of functional change
- Activities and adaptations attempted in session
- Objective performance on standardized or custom measures
- Progress toward documented goals
- Home program and caregiver training provided
Occupational therapy specialty page.
Settings vary widely
- Outpatient rehab
- Hand therapy
- Pediatrics and school-based OT
- Skilled nursing and home health
Use setting-specific templates — school-based documentation differs from SNF progress notes.
Pediatric OT
Include caregiver goals, classroom impact, and equipment recommendations — overlap with pediatrics AI scribe when co-treated.
Dictation workflow
OTs often dictate in the gym or between sessions — mobile access matters.