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Occupational Therapy Genogram Template
A genogram template mapping functional ability, caregiving dynamics, and health history for OT assessment, rehabilitation planning, and OT coursework.
Occupational Therapy Genogram Template
What This Template Shows
Three generations mapped around a stroke patient as the primary person.
The client carries stroke and mobility limitation markers.
His father is deceased with a stroke marker; the same condition, one generation back. His father-in-law is deceased with a heart disease marker. His wife carries an anxiety marker and is positioned as his primary caregiver. He has a close relationship with his daughter and a distant one with his son.
The rehabilitation context is visible in the diagram before any clinical notes are added; a hereditary cardiovascular pattern running on both sides of the family, a spouse who is emotionally very close and likely to take on significant caregiving, and a son whose distance may mean less support during recovery.
This is the family picture an occupational therapist uses to understand what the client is returning to and who will be part of his rehabilitation at home.
The symbol legend is displayed below the diagram. For full definitions and clinical usage, see Genogram Symbols Explained.
When to Use This Template
- Stroke and neurological rehabilitation assessment: map the client's family health history, caregiving network, and key relationships to inform a rehabilitation plan grounded in the client's actual home context.
- Geriatric OT and aging-in-place planning: document the older adult's functional status, caregiver availability, and family health patterns as part of a home assessment or discharge planning process.
- Pediatric OT family context mapping: understand the family routines, parenting dynamics, and household composition that shape a child's occupational performance and participation.
- OT coursework and AOTA-aligned program documentation: meets standard requirements for family-centered assessment documentation across accredited OT and OTA programs.
How to Use This Template
1. Download as-is
Click the PDF or PNG button under the embed to download immediately. Use as a clinical reference, team meeting handout, or teaching example.
2. Customize before downloading
Click "Use this genogram" to open the template in EasyGenogram. Replace the generic labels with real or fictional names, adjust the family structure, and update the health markers and relationship lines to reflect the actual client's family situation and rehabilitation context.
Export as PDF or PNG when done, or share via link with a supervisor or clinical team.
Occupational Therapy Genogram Template
Explore this genogram and adapt it to your needs.
FAQ
What is an occupational therapy genogram template?
An occupational therapy genogram template is a family diagram used in OT assessment to map functional abilities, health history, and caregiving dynamics across the client's family system. It gives the OT practitioner a visual record of who supports the client's daily functioning, what health patterns run through the family, and how the family context will shape rehabilitation participation and outcomes.
How is an OT genogram different from a standard clinical genogram?
The structure and notation are the same, but the clinical focus differs. An OT genogram prioritizes functional ability, disability history, and caregiving roles alongside health markers and relational dynamics. It is used to understand how the family context shapes what a client can do, who helps them do it, and what occupational patterns have been transmitted across generations and may influence the client's recovery and engagement.
What does an OT genogram include?
An OT genogram covers at least three generations and usually includes the client's current health conditions and functional limitations, relevant health history across family members, the caregiving network around the client, key emotional relationships that will affect rehabilitation participation, and any patterns of disability or chronic illness that inform prognosis and treatment planning.
Is this template free for OT students?
Yes. Open and customize it in EasyGenogram at no cost. Students with a valid school email can export free when a professor registers a classroom account; other users export from $9/mo/seat.
Can I use this for an OT coursework or fieldwork assignment?
Yes. The template follows McGoldrick-Gerson-Petry standard notation and includes the health markers and relationship lines relevant to occupational therapy family assessment. Open it in EasyGenogram, adjust the family structure to match your assignment or client, and export as PDF for submission.