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WorksheetsOTIE Adult Psych Worksheet 3
Total questions: 20
Worksheet time: 3600secs
Demographic Data: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
I live with my older sister in Cavite.
I'm a 28-year-old call center agent.
My doctor referred me for occupational therapy.
I started experiencing symptoms three years ago.
Occupational Profile: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
I miss working in my old job as a pastry chef.
I need help taking care of my kids.
I enjoy watching Korean dramas on weekends.
I sleep too much and feel tired all the time.
History of Present Illness: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
I had a breakdown at school and was sent home.
It started after I stopped taking my meds.
I haven't gone outside in two months.
I was diagnosed in college but didn’t follow up.
Subjective Findings (Contexts): For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
Our house is too crowded and noisy for me to concentrate.
I get support from my church group every Sunday.
My mom makes most of the decisions at home.
I don’t feel safe in my neighborhood.
Performance Patterns: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
I always eat dinner with my family at 7 PM.
Every Friday, I do grocery shopping with my cousin.
I brush my teeth before going to sleep.
I light candles every night before praying.
Mental Status Exam: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
Sometimes I hear voices telling me I’m worthless.
I feel like someone is watching me all the time.
I’ve been feeling very irritable lately.
I can’t focus on what people are saying.
Objective Findings (Occupations): For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
I need help preparing meals and doing laundry.
I struggle to manage my bills and expenses.
I rarely go out for groceries anymore.
I sometimes forget to take my meds on time.
Performance Skills: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
I often get confused with instructions involving more than one step.
I can't seem to stay on task when there are distractions.
I fidget a lot during conversations.
I’m not good at keeping my things organized.
Client Factors: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
My right leg shakes when I stand for too long.
I have poor eyesight, especially at night.
I feel like my hands are getting weaker.
I have scoliosis since I was 10 years old.
Assessment / Analysis of Occupational Performance: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
Client demonstrates good social interaction but struggles with time management.
Client needs moderate assistance with self-care tasks.
Client has limited attention span and poor memory recall.
Client shows motivation but lacks focus in tasks.
Medication History: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
I take Fluoxetine every morning after breakfast.
Sometimes I forget to take my anti-psychotics.
My doctor changed my dose two weeks ago.
I stopped taking my meds because they made me sleepy.
Environmental Context: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
I sleep on the floor in the living room because my room is under renovation.
There are five of us sharing one small bedroom.
I don’t have a stable internet connection at home.
The noise outside always bothers me when I’m studying.
Values and Spirituality: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
I believe prayer helps me stay calm.
My faith keeps me going during tough times.
I go to church because it gives me peace of mind.
I offer candles and prayers before taking any exam.
Work and Education History: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
I used to be a secretary before my hospitalization.
I haven’t worked in the last two years.
I dropped out of college because I couldn’t focus.
I enrolled in an online course last year but didn’t finish it.
Social Participation: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
I enjoy joining group activities at the center.
I miss attending birthdays and reunions.
I avoid going to public events because of anxiety.
I often spend time chatting with my neighbors.
Goals for Therapy: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
I want to be able to go back to work someday.
I hope to manage my time and emotions better.
I want to help with chores around the house.
I want to be more confident when talking to people.
ADLs / IADLs: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
I need help dressing, especially with zippers and buttons.
I can manage my hygiene but not my medications.
I can cook basic meals but have trouble using knives.
I usually forget to brush my teeth in the morning.
Personal Factors: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
I was raised in the province with strict parents.
I’ve always been shy and reserved since I was a child.
I speak three languages fluently.
I prefer routines over surprises.
Leisure Activities: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
I play guitar during my free time.
I like to color and draw in my journal.
I listen to music to help me sleep.
I used to play badminton every weekend.
Cognitive Skills: For each OT Initial Evaluation section listed, choose the most appropriate patient statement from the options provided.
I forget what I’m supposed to do after a few minutes.
I can't multitask without getting overwhelmed.
I always misplace my things.
I struggle with remembering people’s names.
