MOHO OPHI-II
Client Name Date and time assessment started Age Address General Practitioner NHS number Assessment completed by: Ratings Key: Completion Date: RiO ID Date and time assessment completed DOB Postcode Gender Male / Female
(10 digit number)
MOHO OPHI-II Occupational Performance History Interview 4= Exceptionally competent occupational functioning 3= Appropriate, satisfactory occupational functioning 2= Some occupational functioning problems 1= Extreme occupational functioning problems
Occupational Identity Scale 4 3 2 1 4 3 2 1 4 3 2 1 4 3 2 1 4 3 2 1 4 3 2 1 Occupational Competence Scale Identifies a desired occupational lifestyle Accepts responsibility Has commitments & values Has interests Found meaning & satisfaction in lifestyle (past) 4 3 2 1 4 3 2 1 4 3 2 1 4 3 2 1 4 3 2 1
Has personal goals & projects Expects success Appraises abilities & limitations Recognises identity & obligations Felt effective (past) Made occupational choices (past)
Maintains satisfying lifestyle Works towards goals Organises time for responsibilities Fulfilled roles (past) Achieved satisfaction (past)
4 3 2 1 4 3 2 1
Fulfills role expectations Meets personal performance standards Participates in interests
4 3 2 1 4 3 2 1 4 3 2 1 4 3 2 1
4 3 2 1 4 3 2 1
Maintained habits (past)
Occupational Settings (Environment) Scale Home-life occupational forms Leisure occupational forms Major productive social group Home life physical spaces, objects & resources Leisure physical spaces, objects & resources Summary: 4 3 2 1 4 3 2 1 4 3 2 1 4 3 2 1 Fulfills role expectations Meets personal performance standards Participates in interests Major productive role physical spaces, objects & resources 4 3 2 1 4 3 2 1 4 3 2 1 4 3 2 1
Referral Onwards? (Please give details) If referring to an organisation outside ONEL (Havering) please complete the Referral Out form
Progress Notes:
Significant Progress Note: HCP Name HCP Signature
Yes / No