OT GOALS

PROBLEM
General
General
General
General
General
Skin
Skin
Medication Management

CODES
G01
G02
G03
G04
G05
G01
G02
G01

Medication Management

G02

Medication Management
Medication Management
Medication Management
Medication Management
Pain
Pain
Pain
Pain
Therapeutic Ex-Manual
Therapeutic Ex-Manual
Therapeutic Ex-Manual
Therapeutic Ex-Manual
Therapeutic Ex-Manual
Therapeutic Ex-Manual
Therapeutic Ex-Manual
Therapeutic Ex-Manual
Therapeutic Ex-Manual
Therapeutic Ex-Manual
Therapeutic Ex-Manual
Therapeutic Ex-Manual
Function
Function
Function
Function
Function
Function

G03
G04
G05
G06
G01
G02
G03
G04
G01
G02
G03
G04
G05
G06
G07
G08
G09
G10
G11
G12
G01
G02
G03
G04
G05
G06

DESCRIPTION
OT Rehab potential excellent for stated goals
OT Rehab potential good for stated goals
OT Rehab potential fair for stated goals
OT Discharge when goals met or patient no longer meets criteria for services
OT Discharge when
Patient/caregiver verbalizes understanding of methods to prevent pressure ulcers
Patient/caregiver verbalizes methods to prevent skin impairment
Patient verbalizes understanding of medication regimen
Patient/caregiver demonstrates knowledge of medication dosage, frequency, actions, side effects, and
interactions
Patient adheres to medication/treatment regimen
Patient/caregiver demonstrates ability to manage anticoagulant therapy safely
Patient/caregiver demonstrates proper prefill of medication planner
Patient/caregiver demonstrates independence in management of injection(s)
Patient verbalizes a decrease in pain level from (intensity/location)
Patient verbalizes understanding of pain management techniques
Patient/caregiver demonstrate effective use of positioning techniques to control pain/pressure
Patient/caregiver demonstrates effective use of orthotic device for
Patient demonstrates Home Exercise Program (HEP) with
Patient demonstrates improved ADL/IADL/mobility by increased ROM of
Patient demonstrates improved ADL/IADL/mobility by increased strength of
Patient demonstrates increased aerobic capacity/endurance for ADL/IADL's as evidenced by
Patient demonstrated improved balance as evidenced by
Patient demonstrates improved vestibular signs/symptoms as evidenced by
Patient demonstrates improved fluid/edema management as evidenced by
Patient will exhibit decreased edema as evidenced by (measurement in cm)
Patient demonstrates appropriate application of compression garments/wraps
Patient demonstrates improved fine motor coordination as evidenced by
Patient demonstrates improved visual/perceptual skills as evidenced by
Patient/caregiver demonstrates
Patient demonstrates safe bed mobility with
Patient transfers safely in/out of tub/shower with
Patient transfers safely on/off toilet with
Patient transfers safely in/out of bed with
Patient transfers safely in/out of chair with
Patient transfers safely in/out of wheelchair with

ORDER
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S

OT GOALS
PROBLEM
Function
Function
Function
Function
Function
Function
Function
Function
Function
Function
Function
Function
Function
Function
Function
Function
(I)ADL
(I)ADL
(I)ADL
(I)ADL
(I)ADL
(I)ADL
(I)ADL
(I)ADL
(I)ADL
(I)ADL
(I)ADL
(I)ADL
(I)ADL
(I)ADL
(I)ADL
Safety
Safety
Safety
Safety
Safety

CODES
G07
G08
G09
G10
G11
G12
G13
G14
G15
G16
G17
G18
G19
G20
G21
G22
G01
G02
G03
G04
G05
G06
G07
G08
G09
G10
G11
G12
G13
G14
G15
G01
G02
G03
G04
G06

DESCRIPTION
Patient transfers safely on/off the floor with
Patient transfers safely in/out of car with
Patient ambulates safely with
Patient ambulates steps/curb safely with
Patient ambulates ramps safely with
Patient ambulates uneven surfaces safely with
Patient ambulates even surfaces safely with
Patient demonstrates manual wheelchair mobility safely with
Patient demonstrates powered wheelchair mobility safely with
Patient/caregiver demonstrates safe use of assistive devices/adaptive equipment with
Patient demonstrates improved sitting balance as evidenced by
Patient demonstrates improved standing balance as evidenced by
Patient demonstrates increased gross motor coordination to improve ADL/IADL/ mobility to
Patient demonstrates adherence with restrictions and precautions (weight bearing/ROM)
Patient/caregiver correctly dons/doffs orthotic/prosthetic safely with
Patient demonstrates improved functional cognition as evidenced by
Patient performs feeding with
Patient performs simple grooming/hygiene with
Patient performs oral care with
Patient performs toileting hygiene with
Patient performs clothing management for toileting with
Patient performs upper body dressing with
Patient performs lower body dressing with
Patient performs sponge bathing in bed with
Patient performs sponge bathing in chair with
Patient performs showering with
Patient performs/participates in meal preparation with
Patient performs/participates in laundry with
Patient performs/participates in housekeeping with
Patient demonstrates safe use of adaptive equipment
Patient correctly dons/doffs orthotic/prosthetic with
Patient/caregiver demonstrates safe, effective use of equipment
Patient/caregiver demonstrates knowledge of fall/safety precautions
Caregiver demonstrates proper body mechanics related to patient care
Patient/caregiver demonstrates home/fire/oxygen safety techniques
Patient maintains level of mobility and participation in ADLs within the limits of disease process

ORDER
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S

OT GOALS
PROBLEM
Safety
Safety
Safety
Safety
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cognition
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary

CODES DESCRIPTION
G07
Patient/caregiver demonstrate safe mobility and transfer techniques
G08
Patient/caregiver verbalizes/demonstrates proper hand washing technique
Patient/caregiver verbalizes/demonstrates compensatory techniques to avoid injury related to sensory
G09
impairment
G06
Patient maintains level of mobility and participation in ADLs within the limits of disease process
G01
Patient demonstrates ability to safely use/manage adaptive equipment in home environment
G02
Patient safely performs at highest functional capabilities
Patient/caregiver demonstrates knowledge of Allen Cognitive Levels & recommended safety
G03
precautions
G04
Patient/caregiver demonstrates knowledge of cognitive impairments
G05
Patient/caregiver will increase ability to improved insight and safety awareness
G06
Patient/caregiver will increase ability to use compensatory strategies for improved cognition at level of
G07
Patient will increase ability to sustain attention to tasks with accuracy of
G08
Patient will increase ability to divide attention with accuracy of
G09
Patient will increase ability to focused attention with accuracy of
G10
Patient will increase ability to orient to person, place, time and event with accuracy of
G11
Patient will increase ability to solve simple problems with accuracy of
G12
Patient will increase ability to solve complex problems with accuracy of
G13
Patient will increase ability to utilize effective judgement/reasoning skills with accuracy of
G14
Patient will increase ability to sequence functional activities with accuracy of
G15
Patient will increase immediate memory skills with accuracy of
G16
Patient will increase short term memory skills with accuracy of
G17
Patient willl increase working memory skills with accuracy of
G18
Patient will increase long term memory skills with accuracy of
G19
Patient will increase use of learned compensatory strategies for memory with accuracy of
G20
Patient will increase ability to initiate functional tasks with accuracy of
G21
Patient will increase ability to inhibit inappropriate/distractive behaviors with accuracy of
G22
Patient demonstrates improved functional cognition as evidenced by
G01
Patient demonstrates improved activity tolerance for ADL/IADL completion
G02
Patient incorporates breathing strategies into daily activities
G03
Patient demonstrates decreased dyspnea with ADL/IADL
G04
Patient/caregiver demonstrates utilization of energy conservation techniques and pacing with ADL/IADL
G05
Patient demonstrates safe use of assistive and adaptive equipment with ADL/IADL
G06
Patient demonstrates adequate oxygenation in ADL/IADL as evidenced by PA02
G07
Patient/caregiver demonstrates/verbalizes understanding of proper/safe use of oxygen and related equipment
G08
Patient/caregiver verbalizes understanding of sternal/cardiac precautions

ORDER
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S

OT GOALS
PROBLEM
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary
Cardiopulminary

CODES
G09
G10
G11
G12
G13
G14
G15
G16
G17
G18
G19
G21
G22
G23
G24
G25
G26
G27
G28
G29
G30
G31
G32
G33
G34
G35
G36
G37
G38

Cardiopulminary

G39

Cardiopulminary
Low Vision
Low Vision
Low Vision
Low Vision

G40
G01
G02
G03
G04

DESCRIPTION
Patient/caregiver demonstrates independence in upper extremity endurance exercise/HEP
Patient maintains stable cardiovascular status at baseline within parameters
Patient has reduced episodes of chest discomfort
Patient has reduced episodes of shortness of breath
Patient/caregiver verbalizes signs/symptoms of cardiac disease
Patient verbalizes methods to decrease edema
Patient will monitor and record weight daily and report if outside of ordered parameters
Patient/caregiver demonstrates understanding of proper use of cardiac medications and side effects
Patient is compliant with low sodium heart healthy diet
Patient is compliant with fluid restrictions and intake monitoring
Patient/caregiver demonstrates proper prefill of medication planner
Patient transfers safely on/off toilet with
Patient transfers safely in/out of bed with
Patient transfers safely in/out of chair with
Patient transfers safely in/out of wheelchair with
Patient transfers safely on/off the floor with
Patient transfers safely in/out of car with
Patient demonstrates safe bed mobility with
Patient demonstrates increased balance as evidenced by improved score of (TUG/Tinetti/BERG)
Patient/caregiver demonstrates safe use of assistive devices with
Patient correctly dons/doffs orthotic/prosthetic safely with
Patient correctly dons/doffs cast/splint safely with
Patient demonstrates independent static sitting balance with
Patient demonstrates independent dynamic sitting balance with
Patient demonstrates independent static standing balance with
Patient demonstrates independent dynamic standing balance with
Patient demonstrates improved aerobic capacity as evidenced by
Patient demonstrates proficiency in use of HELP system
Patient demonstrates safe functional household mobility using least restrictive ambulating device
Patient/caregiver demonstrates understanding on how to decrease exacerbation of disease process and risk of
thrombus
Patient will demonstrate adequate surgical wound healing
Patient/caregiver demonstrates appropriate low vision strategies
Patient/caregiver demonstrates adequate competency in use of adaptive equipment
Patient/caregiver communicates understanding of the benefits of home modification
Patient/caregiver communicates knowledge of available community resources and how to access

ORDER
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S

OT GOALS
PROBLEM
Low Vision
Low Vision
Low Vision
Low Vision
Low Vision
Low Vision
Neuro

CODES
G05
G06
G07
G08
G09
G10
G01

Neuro

G03

Neuro
Neuro

G04
G05

Neuro

G06

Neuro

G07

Neuro
Neuro
Neuro
Neuro
Neuro

G08
G09
G10
G11
G12

DESCRIPTION
Patient/caregiver communicates knowledge of resources and educational materials provided
Patient/caregiver demonstrates the use of Preferred Retinal Location (PRL)
Patient demonstrates understanding of Home Exercise Program to include Pre-Reading and writing exercises
Patient/caregiver verbalizes understanding the importance of using optical devices as prescribed
Patient/caregiver verbalizes understanding of maintenance/proper care of optical devices
Patient demonstrates safety in performing ADL's and IADL's to include functional Mobility
Patient/caregiver applies compensatory strategies for perceptual deficits in ADL/IADLs
Patient/caregiver show good return demonstration of HP for perceptual retraining/remediation in
ADL/IADL
Patient/caregiver communicates/demonstrates understanding positioning to normalize tone
Patient/caregiver demonstrates competence in HEP
Patient/caregiver communicates/demonstrates understanding of positioning for prevention of
contractures
Patient/caregiver communicates understanding and demonstrates application of methods to
reduce falls during ADLs/IADLs
Patient/caregiver demonstrates competent use of adaptive equipment during ADLs/IADLs
Patient will demonstrate reduction in abnormal muscle tone as evidenced by
Patient will demonstrate improvement in normal movement patterns as evidenced by
Patient/caregiver will demonstrate understanding of strategies to compensate for sensory loss
Patient/caregiver will demonstrate understanding of strategies to compensate for tremors

ORDER
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S