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PAVET TM Patient Assessment Validation Evaluation Test Patient Information Name Insurance ID Home Address Amputation side City State Zip Amputation length Short Mid-thigh Long Knee disarticulation Hip disarticulation Date of amputation Date of Birth Ht Wt Sex Age Male Female Left Right Bilateral Home Phone Cause of amputation Work Phone Age of current knee Health Related Information Comments Diabetes No Yes Heart Condition High Blood Pressure Jo...

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