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Occupational Therapist Template

BIST

A professional Occupational Therapist template for healthcare professionals.
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About this template

This BIST (Brief Inventory of Symptoms and Trauma) template is designed for Occupational Therapists and other healthcare professionals to assess concussion symptoms. It helps to document the severity of physical, cognitive, and other symptoms following a concussion. This template allows for a detailed record of a patient's experience, including headaches, light sensitivity, memory issues, and overall impact. With Heidi, this template can be quickly populated from a patient's visit transcript, saving time and ensuring comprehensive documentation.

Preview template

BIST Measure - Concussion Symptom Scale Client: John Smith Date: 1 November 2024 Physical Symptoms - Headaches: 6/10 - Throbbing headaches, occurring daily, lasting for several hours, relieved by rest. - Neck Pain: 4/10 - Stiff neck, worse in the morning, improved with stretching. - Light Sensitivity: 7/10 - Bright lights in the office and outdoors trigger symptoms. - Sound Sensitivity: 5/10 - Loud noises, such as construction, are bothersome. - Dizziness/Balance Problems: 3/10 - Occasional dizziness when turning head quickly. - Nausea: 2/10 - Mild nausea after meals. - Feeling "at sea" with eyes closed: 0/10 - Not present. - Vision Problems: 4/10 - Blurry vision when reading. - Feeling Clumsy: 3/10 - Occasional dropping of objects. Cognitive Symptoms - Taking Longer to Think: 6/10 - Forgetful/Poor Memory: 5/10 - Difficulty remembering recent conversations. - Getting Confused Easily: 4/10 - Trouble Concentrating: 7/10 Other Symptoms - Mood Changes (angry/irritable): 3/10 - "Doesn't Feel Right": 4/10 - Daytime Fatigue: 6/10 - Increased need for naps. - Poor Sleep: 5/10 - Difficulty falling asleep. - Other Symptoms: None Baseline Impact of Injury Score (out of 10): 7/10 - Significant impact on work and social activities.
BIST Measure - Concussion Symptom Scale Client: [Client's full name] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) Date: [Date of assessment] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) Physical Symptoms - Headaches: [Headache severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - [Headache characteristics, frequency, and resolution] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - Neck Pain: [Neck pain severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - [Neck pain characteristics, frequency, and resolution] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - Light Sensitivity: [Light sensitivity severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - [Light sensitivity triggers and specific bothersome situations] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - Sound Sensitivity: [Sound sensitivity severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - [Sound sensitivity triggers and specific bothersome sounds] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - Dizziness/Balance Problems: [Dizziness or balance problem severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - [Nature, frequency, and severity of dizziness/balance problems, including any pre-existing conditions or changes] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - Nausea: [Nausea presence or severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - [Frequency, predictability, and duration of nausea episodes] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - Feeling "at sea" with eyes closed: [Presence of symptom] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - [Scenarios, frequency, and duration of "at sea" episodes] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - Vision Problems: [Vision problem severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - [Specific vision issues such as blurry or double vision, including triggers and duration of episodes] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - Feeling Clumsy: [Clumsiness severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - [Examples of clumsiness] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) Cognitive Symptoms - Taking Longer to Think: [Severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - Forgetful/Poor Memory: [Severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - [Memory types affected, such as short-term memory or name recall] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - Getting Confused Easily: [Severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - Trouble Concentrating: [Severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) Other Symptoms - Mood Changes (angry/irritable): [Severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - "Doesn't Feel Right": [Severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - Daytime Fatigue: [Severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - [Daytime sleep habits, naps, increased breaks or rest periods] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - Poor Sleep: [Severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - [Sleep issues such as trouble falling asleep, total sleep duration, and sleep disturbances] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - Other Symptoms: [Additional concussion-related symptoms not captured above] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) Baseline Impact of Injury Score (out of 10): [Overall impact score] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) - [Specific areas of life affected by recent injuries, such as work, hobbies, or sleep] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.) (Never come up with your own patient details, assessment, plan, interventions, evaluation, and plan for continuing care - use only the transcript, contextual notes or clinical note as a reference for the information included in your note. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes or clinical note, you must not state the information has not been explicitly mentioned in your output, just leave the relevant placeholder or omit the placeholder completely.) (Use as many lines, paragraphs or bullet points, depending on the format, as needed to capture all the relevant information from the transcript.)
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Specialty

Occupational Therapist

Used

7 times

Type

Document

Last edited

28/10/2025

Created by

Anonymous

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