PM&R Survival Guide

Physical Medicine & Rehabilitation Survival Guide

Contributed by Sarah Sabol, MD

Daily Hours

You'll work Monday through Friday, starting at 7:00–7:20 AM. How late you stay depends on when patient care wraps up.

General Daily Workflow

Show up at the Inpatient Rehabilitation Program (IRP) by 7:20 AM at the latest.
Pre-chart and pre-round on patients.
Dr. O's workflow is fluid — he may "run the list" and round with you during, before, or after you pre-round/pre-chart. He is very easy to get a hold of, so don't be shy to contact him if you need him.
Head to the outpatient clinic for follow-ups, procedures, and NCV/EMG testing.
Clinic usually wraps up around 5:00 PM.
New admissions often come in after 5:00 PM, so expect to head back to the hospital fairly regularly.

Team Meetings

Every Tuesday and Thursday at 12:15 PM. Plan on about an hour.
You're excused from didactics these days, but team meetings are mandatory.

Outpatient Clinic

Location: 3526 N Crossing Circle
Use the side door. Code is 3526.
The surgery center for procedures is adjacent. Some procedures are performed inside the outpatient clinic and some in the surgery center.

Computer Systems

When you log in:

Select "Direct supervision"
Provider: Usman-Oyowe, Ibrahim
Free type: SGA IP REHAB PROV

Easy to miss

Change the service in the upper right corner of your note from Internal Medicine to Physical Medicine and Rehabilitation.

You'll use AthenaHealth EHR. Your supervising physician will give you login credentials.

Documentation Tips

The "High-Risk Drug" Table

You'll see this on new patient and discharge notes. Fill it out based on what the patient is taking that day. Include daily prophylaxis anticoagulation if they're on it. For the diabetes/hypoglycemia risk line — if they have diabetes in any form, mark yes.

Daily Progress Notes

For the HPI, keep it brief — just hit the pertinent stuff. Use this template for the review of systems:

"Denies nausea, vomiting, fevers or chills. Denies any chest pain or shortness of breath."

Then edit it if the patient actually has any of those symptoms. Tack it on after your relevant HPI findings.

Time Documentation

Be sure the following statement exists on all daily notes:

"Time spent was 35 minutes with over 1/2 in direct patient care/examination, consultation with nursing, therapists, case manager and coordination of care. This progress note was dictated using voice recognition software. Please excuse any grammatical, word substitution or typographical errors."

Admission Notes

Common admission diagnoses you'll see: critical illness myopathy, debility, CVA.

Start your HPI like this:

"[Patient] was admitted to acute inpatient rehabilitation in the setting of [primary rehab diagnosis] status post [primary hospital problem]. Of note they have a prior history of [relevant past medical history]."

When you reconcile the Internal Medicine diagnosis list, keep as many as you reasonably can — they show complexity for billing. Internal Medicine keeps following these patients during their IPR stay, which means more eyes on them. Under each medicine diagnosis, you can write "Internal medicine on consult" after the basic management. You'll sit down with billing at some point to talk about covered vs. non-covered complicating diagnoses.

Discharge Notes

Be sure to pend in the AM; prioritize doing these first.
Discharge orders are typically put in the night before by Dr. O, and there will be a sheet of paper provided by the case manager specifying the logistics of the discharge. You will need this paper to complete the discharge note.
If you're finishing the discharge note after the patient has already left, find them under "Recent Patients." Don't forget to add the attending's name back at the top.
List any durable medical equipment (DME) recommended under the "Discharge Disposition" section, under a heading you type yourself stating "DME recommended".

Redundant heading

The discharge template has a redundant "Discharge Medications" heading near the end. Delete it — medications are already listed earlier automatically.

Functional History — The Important Part

This is probably the most critical piece of your discharge note. You're documenting how much assistance the patient needed on admission vs. discharge. This requires some detective work through therapy notes.

Assistance Scale

Level	Meaning
1	Total assistance
2	Maximal assistance
3	Moderate assistance
4	Minimal assistance
5	Supervision / setup
6	Independent

Where to Find the Info

Mobility & Transfers: Check PT notes — "Plan of Care" section first, then "Notes".
ADLs: OT notes — be specific about upper AND lower extremity needs.
Cognition, Speech & Feeding: SLP notes (if applicable — not everyone gets speech therapy).

For admission status, use the initial evaluation from each discipline. For discharge status, you can use findings from up to three days before discharge.

Required

You MUST specify the level of assistance (min / mod / max assistance, etc.).

Daily Checklist

[ ] 7:00–7:20 AM — Get to IRP, prep notes, pre-round
[ ] Make sure service is set to "Physical Medicine and Rehabilitation" on all notes
[ ] Finish daily progress notes with proper time documentation
[ ] Head to outpatient clinic
[ ] Tuesday/Thursday 12:15 PM — Team meeting (don't miss it)
[ ] Watch for late admissions after 5:00 PM
[ ] All admission notes due within 24 hours; daily notes by 4:00 PM
[ ] Don't leave until your notes are done or unless excused by attending

Final Thoughts

All discharge orders are performed by Dr. O.
Admissions orders are typically done by him as well, unless otherwise specified. He will teach you how to put in admission orders if he expects that from you.
It is also possible you may be released at 5 PM despite there being late admits. Take the schedule with a grain of salt; this may change if an NP is hired for full-time IPR.

Good luck on your PM&R rotation! Paying attention to documentation details keeps patients safe and billing accurate.

Last update: April 21, 2026