Occupational Therapist Template

BIST

A professional Occupational Therapist template for healthcare professionals.

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Specialty

Occupational Therapist

Used

9 times

Type

Document

Last edited

2025/10/28

Created by

Anonymous

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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.

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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.