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Rehabilitation Tracking Log Template
Track your rehabilitation activities and symptoms in a clear, organized log for doctors, insurers, and attorneys.
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Rehabilitation Tracking Log Template
[Patient / Client Full Name]
[Street Address]
[City, State/Province, ZIP/Postal Code]
[Phone Number]
[Email Address]
Date of Birth: [MM/DD/YYYY]
1. Case and Reference Information
Type of Matter (check or describe):
Motor vehicle accident (may include DUI-related)
Workplace injury
Slip-and-fall / premises incident
Sports or recreational injury
Post-surgical rehabilitation
Other injury or medical condition: [Describe]
Date of Injury / Surgery: [MM/DD/YYYY]
Insurance Company (if applicable): [Name]
Policy / Claim Number: [Number]
Attorney / Law Firm (if applicable): [Name]
File / Case Number: [Number]
2. Summary of Injury and Treatment Plan
Injury / Diagnosis Summary (brief):
[Example: “Lumbar strain after rear-end collision,” “Post-operative ACL reconstruction – left knee,” etc.]
Body Part(s) Affected:
[Example: neck, lower back, right shoulder, left knee, etc.]
Main Providers Involved in Rehabilitation:
Primary Treating Provider: [Name, Specialty]
Therapy Provider(s): [Name(s), Type: PT/OT/Chiropractic/etc.]
Planned Treatment (short overview):
[Example: “Physical therapy 2x/week for 8 weeks, home exercise program daily, follow-up with orthopedist in 6 weeks.”]
3. Tracking Period
This Rehabilitation Tracking Log covers:
From: [MM/DD/YYYY]
To: [MM/DD/YYYY]
4. Daily Rehabilitation Entry (Repeat for Each Day)
Use one block per day. Copy or extend this section as needed.
Date: [MM/DD/YYYY]
Day of Week: [Mon / Tue / Wed / Thu / Fri / Sat / Sun]
4.1 Symptoms and Pain Levels
Body Part(s) Affected Today:
[Example: “Neck and lower back,” “Right shoulder,” etc.]
Pain Level on Waking (0–10): [0–10]
Highest Pain Level During the Day (0–10): [0–10]
Pain Level at Bedtime (0–10): [0–10]
Describe Pain and Symptoms (brief, in your own words):
[Example: “Sharp pain when bending, dull ache while sitting, tingling in right hand,” etc.]
4.2 Treatment and Therapy Received Today
Was there any professional treatment today?
No
Yes – check and describe:
Professional Treatments:
Physical therapy (PT) – [Clinic Name / Focus of today’s session]
Occupational therapy (OT) – [Details]
Chiropractic visit – [Details]
Doctor / specialist visit – [Provider and purpose]
Counseling / psychological support – [Topic/brief note]
Other treatment – [Describe]
Time of Appointment(s): [HH:MM a.m./p.m., list if multiple]
Key Activities or Notes from Today’s Session(s):
[Example: “Worked on core stabilization and hip strengthening,” “Manual therapy to lower back,” “Reviewed ergonomic changes for work.”]
4.3 Home Exercises and Self-Care
Home Exercises Completed Today (check and describe):
Stretching – [Type, sets/reps or minutes]
Strengthening exercises – [Type, sets/reps]
Balance / coordination work – [Description]
Walking or cardio activity – [Distance or time]
Other prescribed exercises – [Describe]
Did you follow any specific self-care instructions?
Ice or cold pack – [Area and duration]
Heat – [Area and duration]
Rest / activity modification – [Describe]
Use of brace, sling, cane, or other device – [Describe]
Other self-care – [Describe]
4.4 Medication Taken (If Relevant)
List medications related to this injury taken today (if any):
Medication 1: [Name and dose] – Times Taken: [e.g., 8:00 a.m., 8:00 p.m.]
Medication 2: [Name and dose] – Times Taken: [Times]
Medication 3: [Name and dose] – Times Taken: [Times]
Side Effects or Issues Noticed:
[Example: “Drowsy after afternoon dose,” “Mild nausea,” or “No side effects noted.”]
4.5 Functional Abilities and Limitations
Work / School Status Today:
Did not work / attend school due to injury
Worked / attended school with restrictions
Worked / attended school full duty
Not employed / not in school
If you worked or attended school, briefly describe any difficulties:
[Example: “Could not sit longer than 30 minutes without pain,” “Needed help lifting items over 10 lbs,” etc.]
Daily Activities Affected Today (check and describe briefly):
Walking or standing – [Description]
Sitting – [Description]
Household tasks (cleaning, cooking, laundry) – [Description]
Driving or transportation – [Description]
Caring for children or family – [Description]
Hobbies or exercise – [Description]
Sleep – [Description, e.g., “Woke up 3 times from pain.”]
4.6 Overall Daily Summary
Overall, compared to yesterday, today was:
Better
About the same
Worse
Brief Daily Summary (in your own words):
[Example: “Pain slightly improved, tolerated PT session well,” “Back worse after long car ride,” “More sore today after new exercises.”]
5. Weekly or Period Summary (Optional)
Use this section at the end of each week or tracking period.
Week / Period Covered: [e.g., “Week of 05/01/2025–05/07/2025”]
Average Pain Level This Week (0–10): [0–10]
Biggest Improvements:
[Short bullet list, e.g., “Can walk 20 minutes,” “Better sleep,” “Less stiffness in the morning.”]
Biggest Challenges:
[Short bullet list, e.g., “Still can’t sit more than 30 minutes,” “Strong pain after PT,” etc.]
Changes in Treatment or Medications:
[Describe any new exercises, added or stopped medications, or changes in visit frequency.]
Questions or Issues to Discuss at Next Appointment:
[Free-text list]
6. Attachments Checklist
Check any items you are keeping with this log:
Therapy or home exercise instructions
Doctor’s visit summaries
Updated work status or restriction notes
Pain or symptom charts or graphs
Copies of appointment schedules or reminders
Other related documents: [Describe]
7. Certification (Optional)
I, [Patient / Client Full Name], certify that the entries in this Rehabilitation Tracking Log are truthful and based on my own experiences during the period covered. I understand that this log may be shared with my healthcare providers, insurer, or attorney to help evaluate my recovery and needs.
Signature: _______________________________
Printed Name: [Patient / Client Full Name]
Date Signed: [MM/DD/YYYY]
Place Signed (City, State/Province): [Location]
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Learn more about
Rehabilitation Tracking Log Template
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
REHABILITATION TRACKING LOG TEMPLATE FAQ
What is a rehabilitation tracking log?
A rehabilitation tracking log is a simple record you keep of your treatment, home exercises, pain levels, and daily limitations during recovery from an injury or surgery. It helps show what you are doing to get better and how your condition changes over time.
Why should I use a rehabilitation log after an accident or injury?
Using a rehabilitation log makes it easier to remember details when you talk to doctors, therapists, insurers, or your attorney. It can show patterns in your pain and progress, support requests for continued treatment, and document your efforts to follow medical advice in a personal injury or workers’ compensation case.
What should I record in a Rehabilitation Tracking Log?
A helpful log usually includes: date, type of treatment or exercise, which body parts were affected, pain scores before and after activity, medications taken (if relevant), what you could or could not do that day, and any notable events such as flare-ups, missed work, or sleep problems.
How often should I update a rehabilitation tracking log?
Many people complete their log daily or on each day they have treatment, therapy, or significant symptoms. Consistency is more important than perfection — short, honest entries made regularly are more useful than long entries once in a while.
Can this rehabilitation log help with insurance or legal claims?
Yes. A clear rehabilitation tracking log can support your reports about pain, limitations, and treatment needs. Doctors, case managers, and attorneys often find this kind of daily record very useful. It does not replace medical records or legal advice, but it can help explain your experience between appointments.
How can AI Lawyer help me with a Rehabilitation Tracking Log?
AI Lawyer can help you format, organize, and customize this Rehabilitation Tracking Log Template so it matches your situation, including the sections you want to track most closely. You still provide the real dates, symptoms, and activities, and you remain responsible for checking everything. This template and any AI-generated content are for document organization only and are not medical or legal advice.
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