Applied Physical Rehabilitation
OCCT2001 & OCCT5005
Applied Physical Rehabilitation
School of Allied Health
Title: Written assignment 2
Student Name:
Student Number:
Email Address:
School/Department: School of Occupational Therapy and Social Work
Unit: Applied Physical Rehabilitation OCCT2001
Lecturer/Tutor:
Date Due:
I declare that I have:
Received and read a copy of the Student Guidelines for Avoiding Plagiarism.
Paraphrased correctly and included a reference to clearly indicate the parts of my work that are drawn from another persons work.
Used direct quotations sparingly and have formatted all quotes correctly.
Provided a reference for every image, diagram or figure that is not my own creation
Included a reference list of all work cited following the referencing protocol required for this unit.
Kept a copy of the original sources (electronic or hard copy) that I have referenced.
NOT used copy and paste to take text from another source
NOT used another students work, shared my work with another student, or submitted someone elses work as my own.
Adhered to the word/ page limit for this assessment
I understand that copying from someone elses work is plagiarism and serious penalties can apply.
I have not allowed anyone else to submit my work as their own, and I understand that this is collusion which is considered academic misconduct.
This assignment is my own work and has not been submitted in any form for another unit, degree or diploma at any university or other institute of tertiary education.
********Read this declaration!!!! If you cannot tick all boxes truthfully, then do not submit your assignment as you may be referred for academic misconduct. If you feel you cannot truthfully tick all boxes, contact the unit coordinator to discuss before the submission deadline.
Student signature:
Date:
Word Count:
Remember to correctly format and reference according to the unit outline
Stick to word LIMIT- please note that there is not 10% either way, it is a limit not a suggestion. You may deduct 350 words from your limit due to the table headings and questions. You must state your word count at the end of the assignment AND on this page (above).
Websites are NOT to be used as references, except for Australian Government sites. You can use approved medical abbreviations that are noted in your case study.
You may use this template if you wish, or use the headings provided in a word document
COMPREHENSIVE OCCUPATIONAL THERAPY PROGRAM
Section 1 and 2: Enter/ Initiate and Set the stage. From the information provided in your case study and further research, discuss the Person, Environment, Narrative and Occupational factors impacting your client (10marks)
Client Name: Age: Medical Diagnosis and reason for referral Note why the client is being seen by you and purpose of referral for occupational therapy
Previous Medical History: Note any other significant medical history or not applicable (N/A), if there is no PMHx
Social Situation: Where the person lives, who they live with, pets, family, marital status- any information that you feel is relevant to your client
Occupation
Roles what roles does your client have? Use the case study information and your knowledge to describe 3 roles
Activities which activities are meaningful? Use the case study information to describe an activity for each of the 3 roles which are meaningful to your client
Tasks what tasks and steps are likely to be completed as part of the desired activities? Review the various sources of information provided (case study notes, application of the model, other occupational therapy literature) to determine 3 roles that the person currently demonstrates.
Referring to the previous roles, determine 1 activity for each of the roles that the person participates in. For each of the 3 activities, describe 1 task and the steps of the task (list of steps needed to complete the task) EG Role: wife, Activity: housework. Task: vacuuming: Steps: taking vac out, wheeling to carpet, plug in cord, fix handle, push and pull over carpet.
Refer to the Module 1 tutorial and lecture
You will have 3 roles, 3 activities, plus 3 tasks and corresponding steps. These will be used to develop the clients goals- choose ones that are suitable within the context of your contact with your client and are appropriate to be addressed.
Person
(barriers/constraints, enablers/capabilities)
Environment (barriers/constraints, enablers/capabilities)
Narrative (past/current/future) You may add plausible information here that you feel would be typical of the person you are working with. Refer to week one reading and lecture. You must reference factual information that is not from the case study e.g. if you said that Perth has an average of 8 hours of sunshine per day, you would need to provide an academically credible source (credible Australian website is OK here) to support this, but if you said Mary plays lawn bowls every week, a reference is not required.
Refer to the PEOP model (2015) narrative headings and discuss your clients personal narrative
Occupational performance and participation What is the current level of performance and participation for the various activities the person wishes to complete?
Provide detailed reasoning and evidence for this section. Provide a summary of the persons current occupational performance and participation
How does this current performance affect their participation in their meaningful occupations and roles?
Use appropriate academic referencing and recent evidence (2010-2021) to support your recommendations
Section 3: Assess/Evaluate (5 marks)
Choose the most appropriate/priority assessment which will help you to develop your goals that could be completed with your client at this time. Provide detailed reasoning and evidence for your selection. Take into account the context, of care, your role as the occupational therapist, the relevant occupational issues, research and discuss an appropriate assessment that would be completed with your client. Use appropriate academic referencing and recent evidence (2010-2021) to support your recommendations.
Section 4: Set Goals and objectives (5 marks)
Your client has completed a Canadian Occupational Performance Measure (COPM) with you. Using this information, and your knowledge of the occupational therapy process, list one long term and two short term goals for your client. Refer to your notes regarding goal setting. Refer to the activities in section 1 and develop into goals which can reasonably be achieved within 3 months.
Consider time periods that would be reasonable based on your knowledge of the clients condition and the context of care (acute, rehabilitation, community).
These goals must include who does what; under what conditions, how well, by when. Refer to Module 4 tutorial notes for further information.
Section 5 and 6: Implement the plan/monitor and modify (10 marks)
Use your knowledge of the clients occupational performance issues and the goals outlined in section four to develop an intervention session that could be reasonably completed in one hour. Summarise recent (published between 2010 and 2021 only) evidence that supports the selected occupation-focussed interventions.
Provide information about how you would monitor and modify your session based on your clients participation. Suggest that you refer to the CMCE strategies, use the OT Toolkit ONLY PAGES SUGGESTED IN LABS AND TUTORIALS, Occupational Therapy for Physical Dysfunction text book and your practice in laboratories to assist you with this. You may include additional supporting material as an appendix e.g. diagrams, pictures, photographs. Include information regarding how you would monitor your clients progress and modify interventions accordingly
Section 7 and 8: Evaluate/conclude and relevant assessment/documentation that applies to your case study(5 marks)
Provide your summary of evaluation strategies and provide a concluding statement regarding your work with your client. In consultation with your client, determine how you will evaluate progress. Use recent evidence to support your work.
Also include any assessments or documentation (as completed in the weekly tutorials) as an appendix that may be relevant to the OT process with your client. The appendix will not count towards to the overall word count.
Section 9: Formatting, presentation, referencing and writing (5 marks)
Formatted according to information, clearly set out with headings/use of template, APA 7th and word count Use APA 7th current version 2019. You may use this template to format your work.1.5 cm spacing. Margins 2.5cm. Do not exceed the word count. Work not adhering to formatting instructions will receive a zero grade for this section
Component Criteria not addressed
0 marks/0 marks
Inadequately addressed
2 marks/1 mark
Developing competency
4 marks/2 marks
Competent
6 marks/3 marks Highly competent
8 marks/4 marks
Excellent
10 marks/5 marks
Enter/initiate
Set the stage
(5 marks)
Background information complete
3 Roles, 3 activities and 3 tasks with steps
Information provided in the case study is missing.
Limited background information provided
Discussion regarding roles, activities and tasks is inadequate.
Basic information only including the following:
Background information provided but 5 or more areas need more information.
Some discussion regarding roles, activities and tasks with more than 6 errors.
Basic information only with some justification as to why it is relevant including the following.
All relevant background information provided but 3 -4 areas need more information.
Developing discussion regarding roles, activities and tasks with more than 5 errors.
Relevant information is explored with sound justification as to why it is relevant including the following:
All relevant background information provided but
3 -4 areas need more information.
3 suitable roles, 3 suitable activities and 3 tasks all relevant to the role with 3 -4 errors
Good analysis of information with strong justification as to why it is relevant including the following:
All relevant background information provided but 1 -2 areas need more information.
3 suitable roles, 3 suitable activities and 3 tasks all relevant to the role with 1 -2 errors
Highly developed analysis of information with excellent justification as to why it is relevant including the following:
All relevant background information included
3 suitable roles, 3 suitable activities and 3 tasks all relevant to the role with no errors.
Enter/initiate
Set the stage continued:
(5 marks)
Person, Environment and narrative factors included
Occupational performance and participation summary
Evidence required to support work
Personal, narrative and environment factors are not explored. Barriers and enablers are not addressed.
OP and P not summarised.
Evidence not cited
Personal, narrative and environment factors are briefly explored with more than 6 errors.
Barriers and enablers are insufficiently addressed.
OP and P are unclear.
Evidence used is not well articulated Personal, narrative and environment factors are briefly discussed with more than 5 errors
OP and P are clear but requires further development
Evidence is used adequately to support work Personal, narrative and environment factors are very well discussed with1 -2 errors.
Barriers and enablers are well developed and articulated. 3 -4 barriers/enablers not addressed or wrong or not applicable
Good attempt of OP and P summarising barriers/enablers and the impact on the role
Sound use of evidence to support discussion.
Personal, narrative and environment factors are very well discussed with1 -2 errors.
Barriers and enablers are well developed and articulated. 1 -2 barriers/enablers not addressed or wrong or not applicable
Very good summary of OP and P summarising barriers/enablers and the impact on the role
Evidence well researched to support information.
Personal, narrative and environment factors are very well discussed with no errors.
Barriers and enablers are highly developed and articulated.
Excellent summary of OP and P clearly summarising the barriers/enablers and the impact on the occupational role.
Very well developed use of evidence
Assess Evaluate
(5 marks)
Choose the most appropriate/priority assessment which will help you to develop your goals
Evidence required to support work
Information provided in the case study is missing or additional assessment not relevant or inappropriate to the context.
Evidence not used to substantiate work Basic information only.
Additional assessment is somewhat relevant to the context and clients issues.
Some evidence to support work Basic information only with some links to previous sections.Additional assessment is relevant to context.
Evidence is used adequately to support workRelevant assessment used and linked to clients occupational performance issues and context.
Sound use of evidence to support discussion. Highly relevant assessment discussed that is appropriate to the clients OP issues and practice context.
Evidence is used well to support discussion.
Excellent choice of assessment that has strong correlation with the clients occupational performance issues and the context of care.
Evidence used is excellent and very well discussed.
Set goals and objectives (5 marks)
Goal setting- using the recommended headings Goals are not occupation based, OR components are not present OR goals are not relevant to the client OR care context Goals are not occupation based, OR components are not present.
Goals are poorly developed, not relevant to the care context or client Goals are not occupation based OR all components are not present or relevant to care context.
Goals somewhat relevant to client Goals are occupation based and linked to meaningful occupations past and present and care context.
All components present.
Goals are occupation based, well-constructed and highly relevant to meaningful occupations past and present and care context.
All components present. Goals are occupation based, very well-constructed and highly related to meaningful occupations past and present and care context.
All components present
Implement the plan/monitor, modify (10 marks)
Use of suitable, occupation -focussed strategies
Evidence required to support work Interventions do not address goals, valued occupations or refer to suitable strategies.
Interventions do not relate to the Physical Rehabilitation context.
Research into the interventions not adequately completed
Information regarding monitor/modify not included.
Suitable evidence not used. Interventions are poorly researched, with few links to goals, or valued occupations or suitable strategies.
Interventions are not plausible in the physical rehabilitation context.
Some attempt to discuss monitor/modify.
A minimum of 2 journal articles used Some evidence of research into interventions. Interventions attempt to address goals and valued occupations.
Some attempt to use strategies. Some of the interventions relate to the Physical Rehabilitation context.
Discussion regarding monitoring and modifying is developing.
A minimum of 3 journal articles used. Evidence of good research into interventions. Interventions address goals and valued occupations. Good discussion regarding suitable occupation-focussed strategies.
Interventions mostly relate to the Physical Rehabilitation context
Sound strategies for monitor/modify are discussed.
A minimum of 4 journal articles used Evidence of very good research into interventions.
Interventions address goals and valued occupations. Multiple strategies used concurrently.
Interventions closely related to the Physical Rehabilitation context. Well-articulated strategies for monitor/modify.
A minimum of 5 journal articles used Evidence of outstanding exploration regarding interventions. Interventions address goals and valued occupations.
Multiple occupation-focussed strategies used and supported by relevant evidence.
Interventions highly relevant to the Physical Rehabilitation context.
Excellent strategies discussed for monitor/modify.
A minimum of 6 journal articles used.
Evaluate/conclude (5 marks)
Evidence required to support work
Appendices Evaluation of progress not discussed.
No appendix included.
No supporting documentation or assessments included. Evaluation strategies are not adequately discussed.
Appendix is missing information.
More than 7 errors in documentation provided Some ideas regarding the evaluation of progress.
Appendix is missing information.
More than 7 errors in documentation provided and communicating this to others are discussed.
Sound evaluation strategies discussed.
Appendix with a copy of a the following included:
Relevant assessment(s)
Intervention plan
Continuation notes (any format SOAP, DAP or IEP)
5 -7 errors in documentation provided. Very good evaluation strategies discussed.
Appendix with a copy of a the following included:
Relevant assessment(s)
Intervention plan
Continuation notes (any format SOAP, DAP or IEP)
3-5 errors in documentation provided. Excellent evaluation strategies applicable to the practice context.
Appendix with a copy of a the following included:
Relevant assessment(s)
Intervention plan
Continuation notes (any format SOAP, DAP or IEP)
No errors in documentation provided.
Formatting and writing (5 marks)
Word count included Referencing does not conform to APA 7th standards (more than 10 errors)
Word limit exceeded OR formatting incorrect OR very poor academic writing skills demonstrated.
Assignment not labelled correctly Referencing does not conform to APA 7th standards (more than 8 errors).
Word limit exceeded OR formatting incorrect OR poor academic writing skills demonstrated.
Assignment not labelled correctly Referencing conforms in part to APA 7th standards (more than 8 errors).
Word limit exceeded OR formatting incorrect OR inadequate academic writing skills demonstrated OR Assignment not labelled correctly Referencing conforms mostly to APA 7th standards (no more than 5 errors).
Within word limit.
Formatting correct and competent academic writing skills demonstrated.
Assignment labelled correctly Referencing conforms mostly to APA 7th standards (no more than 3 errors).
Within word limit.
Formatting correct and well developed academic writing skills demonstrated.
Assignment labelled correctly Referencing conforms fully to APA 7th standards.
Within word limit.
Formatting correct and very well developed academic writing skills demonstrated.
Assignment labelled correctly
FREMANTLE HOSPITAL AND HEALTH SERVICE
INTEGRATED MEDICAL RECORDS SURNAME: Davies URMN: M625197 SEX: M
FORENAMES: Justin BIRTHDATE: 18/04/1965
ADDRESS: 10/74 Lincoln Street, Highgate 6015
20/05/present date Medical admission: Dr C. Johns- Registrar
1100hrs 55 year old male
Presents with painful R foot ulcer
PMH: Colorectal Ca
Dx 4 weeks
Yet to commence treatment
T2DM
Dx 4 weeks ago
Metformin monotherapy
HbA1c 7-8%
Peripheral Neuropathy
? Related to T2DM. No cause noted
HTN
Presenting complaint
3/7 worsening pain and swlling R foot
Known wound on plantar aspect of foot, unsure of progress
No systemic symptoms of fevers, chills, nausea
MEDS: metformin 500mg twice daily
Ramipril 2.5mg
All: NKDA
O/E: BP 145/80 HR: 75 regular RR: 20 SATS: 98% RA
Heart sounds normal
Absent sensation to monofilament on plantar aspect of feet bilaterally. No motor deficits.
Neurological exam otherwise NAD.
Wound: R plantar aspect- 2 x 2 cms punched out ulcer under 1st MTP. No Pus.
Surrounding cellulitis
Issues: Neuropathic ulcer R foot
Neuropathy out of keeping with early T2DM
Plan: Add empagliflozin for diabetic control
Commence IV augmentin for infection
Podiatry R/V
Neurologist review re: peripheral neuropathy
Urine ACR- evaluate for diabetic nephropathy
A/H team review and discharge planning
-------------------------------------------------------------------------C. Johns #2323----------------------------
20/05/present date Nursing: New patient admitted to ward, Bed 06 at 0945hrs. Mr Davies presents with a right
1130hrs foot, stage 4 pressure area around head of 1st metatarsal (plantar). Wound management
plan completed. Mepilex dressing in place over wound. Daily dressing changes noted.
History of obesity (160kg) , diagnosis of bowel cancer and T2DM 4/52 ago, Peripheral
neuropathy, Hypertension. Nil known allergies. Justin scheduled to commence daily
pre-surgical radiation therapy in 2/52 as an outpatient in the Radiation Oncolgy Unit. Will
receive concurrent chemotherapy via continuous infusion pump over the course of his
radiation therapy. Message left with oncolgy re: Mx plan due to current inpatient status.
BP:145/80mmHg. HR: 75bpm. RR: 20bpm. O2 sats 98% RA (Room air)
Neuro: Presents as alert and orientated ? Withdrawn *** Complaints of tinging in lower
limbs during full hoist transfer onto bed. Sides up, call bell in reach. Falls risk assessment
completed. Lower limbs warm to touch. Right lower limb noted to be hot, swollen and red.
Respiration: Respiratoy assessment NAD. Gastro: NAD. IV cannula in situ (dorsum R hand)
Patient states nil issues with eating once set up on ward. Full assistance with bowel
Management. Pressure area Risk Assessment updated. Psychosocial: Separated, lives alone
Next of kin (NOK) notified of transfer to ward. Equipment: urinal at bedside.
For AH review, wound management, discharge planning----------------S.Thomas (RN)
20/05/present date Occupational therapy: Initial contact and assessment with Mr Davies who was admitted
1150hrs with stage 4 pressure area on plantar aspect of right foot (1st MTP). Diagnosed with bowel
cancer and T2DM 4/52. Sitting up in electric hospital bed on OT arrival. Introduced role of
Occupational Therapy. For full details of assessment refer initial assessment form in
medical record. Mr Davies describes his mood as worried and low and that he has been
having difficulties managing his health and medical conditions prior to admission. Justin
states that his life has changed considerably in the last 4/52. He feels he has gained weight
and lost all motivation to exercise.
Current Occupational Performance Summary:
- Justin currently a full hoist transfer on ward due to NWB status in R) foot 2nd to wound
- Set up assistance required with eating in bed using bed tray
- Set up assistance with grooming in bed. Nursing staff placing all items within reach (bowl,
hair brush, tooth brush, etc)
- Max assist with hoist transfer from bed to wheeled commode for bathing. Once setup,
independent upper body (UB), Max A with lower body (LB). Significant SOB ++.
- Currently only wearing hospital gown, Mod A x 1 to don it when lying in bed.
Occupational Performance Plan
- Due to Justins current weight of 160kg, Justin requires full hoist transfer on ward from
bed to bariatric wheeled commode, HBC and MWC. 2 x staff to push in MWC. Awaiting permission
- Awaiting go ahead from PT and medical team to trial Justin with a bariatric wheeled
zimmer frame during transfers. Will complete joint assessment with PT once approved.
- Requires medical follow up and plans
- Will commence self care review 1/7
--------------------------------------------- H. Joans (Harriet Joans, Occupational Therapist) #4987---
20/05/present date Physiotherapy: Initial mobility review with Mr Davies, admitted to ward with R) foot ulcer.
1300hrs Currently NWB in R) foot. Dressing in situ. Consent gained.
Current transfers and mobility status on ward:
T/F: full hoist (XL sling size) on ward from bed to HBC/Wheeled commode/MWC/Bed
Mobility: MWC on ward only with 2 x staff pushing
Bed mobility: Slide sheets x 2 for repositioning as appropriate otherwise full hoist
Standing balance: Not assessed due to NWB status
Sitting balance: Nil issues noted SOEOB or in HBC or MWC
Plan: full mobility and transfer review once medical permission to trial a bariatric wheeled
zimmer frame granted. Will F/up 1/7 with medical team
- Liaise with occupational therapy re: bariatric electric wheelchair to facilitate access to gym
------------------------------------S Richards Sam Richard, PT #9898------------------------------------
FREMANTLE HOSPITAL AND HEALTH SERVICE
Occupational Therapy Initial Assessment SURNAME: Davies URMN: M625197 SEX: M
FORENAMES: Justin BIRTHDATE: 18/04/1965
ADDRESS: 10/74 Lincoln Street, Highgate 6015
6014720121285Occupational Therapy Initial Assessment
00Occupational Therapy Initial Assessment
MEDICAL INFORMATION
Diagnosis: pressure area 20mm (length) x 20mm (width) x 5mm (deep) on plantar aspect of right foor, approximately over first metatarsal head. Non Weight bearing (NWB) currently
PAIN Yes No Pain and swelling in right foot noted. 3/10 on Visual Analogue Scale (VAS) at rest.
Relevant Medical History/ Medications: Bowel cancer diagnosis 4/52 ago. Diagnosed with type II diabetes (T2DM) during cancer investigations. History of peripheral neuropathy, hypertension, Varicella @ 7 years old. Obesity, Justin is 160kg at 175cm tall. Noted increase in low mood over past year (marriage breakdown 12 months ago). Metformin 500mg bd, Ramipril 2.5mg. Continuous infusion of chemotherapy 5FU which commences same day as radiation therapy (planned but not commenced).
Vision:Within normal limits (WNL)
Hearing: No abnormalities detected (NAD)
SOCIAL SITUATION: Lives alone: Yes No With whom:
Justin is a 55-year-old male who separated from his wife Julia (previously married for 15 years) 12 months ago. Nil children. Justin moved out of the family home 8 months ago to a rental property.
Please choose the cultural background, personal narrative, values and choices for your client as preferred.
Services: Personal Care Assistance Home Help MOW Other Nil
Social activities/Interests/Employment:
Justin worked as a store manager at a small local supermarket for the past 10 years. He enjoys his work but has recently taken paid sick leave due to health issues. Justin states he doesnt get out much, preferring his own company which has resulted in him feeling increasingly isolated and house bound over the past 5 years. Recently he feels he has spent most of his time attending appointments or sleeping/resting. He made comment of his best friend since high school- Ian. They previously attended trivia at the local pub and went for coffee however this hasnt happened for a while. Justin previously enjoyed playing golf and was an active member of the golf club, but over the last 5 years, his involvement with golf has also steadily decreased.
HOME ENVIRONMENTPrevious Home Visit: Yes No
Own Rented House Flat/ Unit Storey: Single Double
Front Access: Justin reports 1 step at the front door (approx. 100mm) with wooden double door
Back Access: 1 x hob step reported
Internal: Door width 700mm throughout house except bathroom where it is 650mm
Bathroom: Shower over bath with shower curtain
-542290-82867500Toilet: In bathroom, adjacent to shower over bath
Bedroom: king sized bed
Seating: Mainly sits on office chair due to difficulty with couch transfers
Other: N/A
Transport: Drives Yes No Manual Auto
Public Transport: Tram Train Bus Disabled Parking Permit
Note: Justin has a C class drivers license and his own car but lately he reports limiting his driving due to increasing difficulty getting in and out of the car. Justin fears getting stuck in the car. Justin doesnt use public transport, as the closest bus stop is 500m from home and he is unable to walk the distance.
CURRENT LEVEL OF FUNCTION
Ambulation Weight bearing status: FWB PWB NWB
Independent Supervision Assistance No Aid Aid currently full hoist transfer on ward to MWC
UPPER LIMB FUNCTION
Dominance: Right Left
Impaired: Yes No ROM Sensation Coordination
OCCUPATIONAL PERFERFORMANCE AREAS
Key: I = Independent A = Assistance required S = Supervision/Prompts
Previous Status
Comments (Aids used) Key Current Status
Comments (Aids used) Key
Ambulation/mobility Difficulty, unable to walk 500m I Non Ambulant at present. A
Bed mobility Increasing difficulty I Full hoist with XL sling on ward A
Transfers Increasing difficulties rising from chair and couch I Full hoist with XL sling on ward A
Personal care ADL Eating I I Set up assistance in hospital bed A
Grooming I I Set up assistance in hospital bed with items on tray table A
Dressing Increasing difficulty with lower body reported I Currently only wearing hospital gown. Requires further assessment and review. A
Bathing Increasing difficulty with washing back, lower body, feet I Max assist, hoist transfer bed to wheeled commode. Once setup, independent upper body, SOB ++. A
Toileting Increasing difficulties with toilet transfer and perineal care I Max assist with hoist to wheeled commode and with perineal hygiene A
Domestic ADL Meal Preparation Made only quick and easy options. Favoured fast food I Not yet assessed on ward ?
Housework With difficulty, wasnt doing much I Not yet assessed on ward ?
Laundry Sporadic, with difficulty I Not yet assessed on ward ?
Garden/Home Maintenance N/A n/a Not yet assessed on ward ?
Community ADL Shopping Increasing difficulties I Not yet assessed on ward ?
Other I I COGNITION NAD Impaired
Low mood noted from observation and from team discussion- for further review
PATIENT GOALS
To complete next session as interrupted by medical ward round
OCCUPATIONAL THERAPIST
Name: Harriet Joans Signature: H.Joans Contact: #4987
Date: 20/5/present date
62185551104900Occupational Therapy Initial Assessment
00Occupational Therapy Initial Assessment
