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Unit Record No. Surname Other Names Princess Alexandra Hospital Health Service District Brain Injury Rehabilitation Service Hypertonicity Clinic Assessment Form (PRE and postBotulinum Toxin Injection

How to fill out hypertonicity clinic assessment form

How to fill out hypertonicity clinic assessment form:

1. Start by entering your personal information at the top of the form, including your full name, date of birth, and contact details.
2. Next, indicate the reason for your visit or referral to the hypertonicity clinic. Provide a brief description of your symptoms or condition that led you to seek this assessment.
3. The form may include sections to record your medical history. Answer questions about any previous diagnoses, surgeries, or treatments related to hypertonicity or other relevant conditions. Be as specific and detailed as possible.
4. If you are currently taking any medication, indicate the names, dosages, and frequencies in the appropriate section of the form. This information helps the healthcare provider understand your current treatment plan.
5. Describe your current symptoms or concerns related to hypertonicity. Include details such as the duration, intensity, and any factors that worsen or alleviate your symptoms.
6. The form may require you to rate the severity of certain symptoms or limitations caused by hypertonicity. Use the provided scales or guidelines to provide accurate assessments.
7. If you have undergone any previous assessments or tests related to hypertonicity, provide details about the procedures performed, dates, and the results, if available.
8. In some forms, there may be a section dedicated to family medical history. If applicable, indicate any relatives who have been diagnosed with or have a history of hypertonicity or related conditions.
9. Finally, review the completed form, ensuring all information is accurate and complete. Sign and date the form as required before submitting it to the clinic or healthcare provider.

Who needs hypertonicity clinic assessment form:

1. Individuals who experience symptoms associated with hypertonicity, such as increased muscle tone, stiffness, or spasticity, may need to fill out a hypertonicity clinic assessment form. This form helps healthcare providers understand the patient's condition, medical history, and specific symptoms to guide further evaluation and treatment.
2. Patients who have been referred to a hypertonicity clinic by their primary care physician, neurologist, or other healthcare professionals may also need to complete this form. It serves as a comprehensive tool to gather essential information before the clinic visit.
3. Patients undergoing follow-up assessments or treatments for hypertonicity may be required to update or fill out a new assessment form during their visits. This ensures that the healthcare provider has the most up-to-date information to address any changes in the patient's condition or symptoms.

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