Allied Health Treatment Plan and Delegation Template
v1.5
Purpose. Allied health professionals use this template to document a patient's assessment findings, goals and treatment plan and to delegate specific program tasks to an allied health assistant with clear limits and reporting requirements.
1.When to use this template
Complete this template after the initial assessment for every patient who will receive a program delivered wholly or partly by an allied health assistant, and update it at every review. It is the authority for the assistant to deliver the program.
2.Assessment and goals
Record the referral reason, the relevant history, the assessment findings and the functional goals agreed with the patient in their own words. Goals must be specific and measurable with a review date.
3.Program and delegation
Describe each exercise or activity, the dose (sets, repetitions, duration, frequency), the equipment and the progression rules. State exactly what the assistant may deliver, what they must not change, and the signs that require them to stop the session and contact the treating professional.
- Stop and report chest pain, dizziness, new or worsening pain above the agreed level
- Do not progress load or difficulty without the professional's approval
- Record every session in the patient record the same day
- Report non-attendance and any change in the patient's condition
4.Supervision
State how the assistant will be supervised (direct, indirect or remote), how often the professional will review the patient and the method the assistant will use to report progress. Supervision arrangements must reflect the patient's risk and the assistant's competence.
5.Review and discharge
At review, record progress against each goal, changes to the program and whether the patient continues, is discharged or is referred back to the general practitioner. Send the review summary to the referring practitioner.