Get the free Upper Extremities Assessment Form Dec 2014

Title: Microsoft Word Upper Extremities Assessment Form Dec 2014 Author: Trish Created Date: 12×18/2014 4:22:14 PM

How to fill out upper extremities assessment form

How to fill out the upper extremities assessment form:

1. Start by carefully reading the instructions provided on the form. Make sure you understand the purpose of the assessment and the information required.
2. Begin by entering your personal information accurately. This may include your name, date of birth, contact details, and any relevant identification numbers.
3. If applicable, provide details about the healthcare provider who referred you for the assessment. This may include their name, contact information, and any relevant specialty or title.
4. The form may ask you to indicate the reason for the assessment. This could be a specific injury, condition, or symptom you are experiencing.
5. In the relevant sections of the form, describe your specific upper extremity symptoms or concerns in detail. This may include information about pain, weakness, limited range of motion, or any other relevant factors.
6. If you have had any previous assessments, surgeries, or treatments related to your upper extremities, make sure to mention them accurately. Include dates, names of healthcare providers, and any relevant details.
7. Some forms may ask for information about your medical history and any pre-existing conditions. Provide accurate details about any relevant health issues, allergies, medications, or surgeries you have had in the past.
8. Use additional space or sections on the form to provide any additional information or notes that may be helpful for the healthcare professional conducting the assessment.

Who needs upper extremities assessment form?

1. Individuals who are experiencing upper extremity symptoms such as pain, weakness, or limited range of motion may need to fill out an upper extremities assessment form.
2. This form is especially relevant for those who have suffered an injury or have a medical condition that affects their upper extremities, including the hands, wrists, arms, and shoulders.
3. Healthcare professionals, including physicians, physical therapists, and orthopedic specialists, may use the upper extremities assessment form to gather comprehensive information about a patient's upper limb function and determine an appropriate treatment plan.
4. Individuals undergoing rehabilitation or therapy for upper extremity issues may need to fill out this form at various stages of their treatment to track progress and modify interventions if necessary.
5. Employers or insurance companies may also require individuals to complete an upper extremities assessment form when filing a worker's compensation claim or seeking coverage for medical treatments related to upper limb injuries.

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What is upper extremities assessment form?

The upper extremities assessment form is a document used to evaluate the condition of a person's arms, shoulders, and hands.

Who is required to file upper extremities assessment form?

Employees who are at risk of developing upper extremity musculoskeletal disorders are required to file the form.

How to fill out upper extremities assessment form?

The form should be completed by providing accurate information about the individual's symptoms, medical history, and work environment.

What is the purpose of upper extremities assessment form?

The purpose of the form is to assess the risk of developing upper extremity musculoskeletal disorders in individuals and to provide necessary interventions.

What information must be reported on upper extremities assessment form?

Information such as symptoms, medical history, work tasks, and ergonomic factors must be reported on the form.