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C533 PT FIRST REPORT Box 2415 Edmonton AB T5J 2S5 Fax (780) 427-5863 1-800-661-1993 WEB Claim Number: Personal Health Number: Worker: Surname First Name Address: Apt/Unit Street Postal Code: Date

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How to fill out including functional status

How to fill out including functional status:

01

Begin by providing your personal information such as your name, date of birth, and contact details.

02

Next, describe your current functional status by evaluating your ability to perform various activities of daily living. These may include tasks like walking, dressing, bathing, eating, and using the bathroom.

03

Provide detailed information about any assistive devices or aids you use to support your functional abilities, such as a cane, walker, or wheelchair.

04

If you have any specific health conditions or impairments that impact your functional status, make sure to mention them and provide additional details as necessary.

05

You may also be asked to rate your level of independence in performing these activities on a scale, such as "dependent," "partially dependent," or "independent."

06

Finally, it is important to be truthful and accurate when filling out this section to ensure that the information is reliable and beneficial for healthcare professionals assessing your overall health and determining appropriate care.

Who needs including functional status?

01

Individuals applying for disability benefits or eligibility for certain assistance programs may be required to include information about their functional status.

02

Patients undergoing medical evaluations or assessments may need to provide their functional status to help healthcare professionals understand their capabilities and tailor their treatment plans accordingly.

03

Functional status information can also be useful for researchers studying the impact of certain conditions or disabilities on an individual's ability to function in daily life. Consequently, researchers may request this data for their studies.

By including functional status in various contexts, it helps ensure that individuals receive the appropriate support, care, and accommodations necessary to improve their overall well-being and quality of life.

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