Therapeutic Recreation Referral Form
as used in a nursing home
submitted by Linda Buettner
Therapeutic Recreation Referral Form "Therapeutic recreation is the provision of treatment services and recreation services to persons with illnesses or disabling conditions. The primary purpose of treatment services which is often referred to as recreation therapy, is to restore, remediate, or rehabilitate in order to improve functioning and independence as well as to reduce or eliminate the effects of illness or disability. The primary purpose of recreation services is to provide recreation resources and opportunities in order to improve health and well-being. Therapeutic recreation is provided by professionals who are trained and certified (CTRS) to provide therapeutic recreation" ATRA 1997 Resident Name_____________Date of referral: ________________ Reason for referral: ______________________________________ Possible areas for referral:
Priority of problem areas to be addressed: Referral made by: ________________________________________ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TR assessment completed by: ______________________________ Date assessment completed: _______________________________ Recommendations:
M.D. notified and date: M.D. orders attained: |