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    Physiotherapy Assessment

    Uploaded by

    Sumit Sardana
    AA

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    © All Rights Reserved
    Download as PDF or read online from Scribd

    Physiotherapy Assessment

    Uploaded by

    Sumit Sardana
    2 views4 pages
    AA

    Original Title

    physiotherapy assessment

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    © © All Rights Reserved

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    AA

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Download as pdf
    2 views4 pages

    Physiotherapy Assessment

    Uploaded by

    Sumit Sardana
    AA

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Download as pdf
    of 4
    LIFE CARE HOSPITAL FATEHABAD Physiotherapy Assessment Sheet 4. Patient Profile Name Sect lent age: © sex: f° Father/Husband/Guardian Name Roum — kenrar Tel.No.: 41 85O4243L- cmon: == pose at escenario. i UHID No, :_13:4810 No.: == Consultant ncharae : <6) Pokus? = foova » Occupation: _@p + _ Handedness (RT) = (LI Health Habit Do you exercise regularly [-1Yes [No Do you use tobacco products [ 1Yes No Other medical ines [ |Heartdiseases — fetHypertension §—[_ ] Stroke { [Diabetes { 1Cancer [partis [ [Kidney problem —_[_ [Infectous disease [~ Others Have you ever had surgery { 1¥es LANo Have you been diagnosed with pregnancy [1] {hor you think you are pregnant # Current limitations: Difficulty in movement in bed (turning in bed, gettfig up from bed) Difficulty in transfer ({rom bed to chair, bed to'éommode) Dificuty in walking (on surface level, on stars, on rfp, on uneven surtace) Difficulty in sett care (bathing, dres¥Ag, eating. holding) Difficuty with home management (household work, shopping, diving) History of current problem: Since how long? what makes he problem worse? Mtoe « What ease the problem? Weg ou T bed 0)112131415161 718191 10 2@® X Mild Moderate severe Page 1 of 2 Scanned with CamScanner How do you descnbe your pain-sharp, dull, burning, acting, tingling, numb constant, variable, radiating, On observation: swelling/oedema ~~ skin changes On palpation: Temperature changes ___Tendemess (On examination: Joint ROM Muscle Tone: Muscle power ~~ Muscle wasting Deformity; Limb length measurement: Gait pattern, Special test PHYSICAL THERAPY MANAGEMENT oe AB} Sime Breebn Sign OF Doctor. Page 2 of 2 Scanned with CamScanner LIFE CARE HOSPITAL FATEHABAD Physiotherapy Assessment Sheet 1. Patient Profile Name: Rat Mth _ age: PY sex: Af FatherlHusbandiGuardian Name: —__$/o bn (steel rns 99 1%2.8431>~ E-mail ID: purpose of presence in hospital: —_I&avee +e? UHID No. : 122.447 IP No. —__consuttantincharge: __ r-Var eu AR Rey Occupation : — Handedness (RT) wn Health Habit Do you exercise regularly nee { ]No acs fore in Other medica illness: [ ]Heartdiseases L-4Fiypertension —[__] Stroke [ [Diabetes { 1Cancer [1 Arthitis [ [Kidney problem (_ JInfectious disease [_] Others Have you ever had surgery [res [No Have you been diagnosed with pregnancy [| [ Joryou think you are pregnant p) A— Current limitations: Difficulty in movement in bed (turning in bed, getting up from bed) no | Difficulty in transfer (from bed to chair, bed to commode) pO Difficulty in walking (on surface level, on stairs, on ramps, on uneven surface) Yuk Difficulty in self care (bathing, dressing, eating, holding) No home management (household work, shopping, diving). Ditficuty wit History of current problem: Since how long? = What makes the problem worse? 7 Onete b wer Lit ps fou fleng = What ease the problem? How do you rate the level of your pain? oi 4i816171919170 © © ® Mild Moderate severe Page 1 of 2 Scanned with CamScanner How do you describe your pain-sia imb constant, variable, radiating ull, burning, acting, tingling, NM] b= skin changes ile (On palpation: Temperature changes ped ——Tendernmss yf varies Youre On examination: Joint ROM Muscle Toney ~~ Muscle power: Muscle wasting: 7 Deformity: Limb length measurement: On observation: swellng/oedema Gait pattern: Special test PHYSICAL THERAPY MANAGEMENT D op Cswdhe Susy Pu buA Date yf) Deyo Time «02.180 (a Sign Of Doctor, Page 2 of 2 Scanned with CamScanner

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