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Canada WCB Functional Examination Record Upper Quadrant Assessment - Saskatchewan 2015-2025 free printable template

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Health Care Services Email: ASECB wcbsask.com Online: www.wcbsask.com/careproviders200 1881 Start Street Regina, Saskatchewan Canada S4P 4L1 Tel: 306.787.4370 Toll free: 1.800.667.7590 Fax: 306.787.4311
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How to fill out Canada WCB Functional Examination Record Upper Quadrant

01
Obtain the Canada WCB Functional Examination Record Upper Quadrant form.
02
Begin by filling out the patient’s personal information, including name, date of birth, and WCB claim number.
03
Document the patient's medical history relevant to the upper quadrant injury.
04
Record the date of the functional examination.
05
Assess the range of motion in the shoulder, elbow, and wrist, and fill in the measurements.
06
Evaluate muscle strength in all relevant muscle groups and note the findings.
07
Document any pain levels or symptoms experienced during the examination.
08
Include observations regarding functional abilities and limitations.
09
Provide any recommended interventions or future assessments needed.
10
Sign and date the form upon completion.

Who needs Canada WCB Functional Examination Record Upper Quadrant?

01
Healthcare professionals conducting assessments for individuals with upper quadrant injuries.
02
Claimants seeking to document their functional abilities related to a Worker's Compensation Board (WCB) claim in Canada.
03
Occupational therapists and physiotherapists involved in rehabilitation programs for upper body injuries.
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The Canada WCB Functional Examination Record Upper Quadrant is a standardized document used to assess and document the functional abilities and limitations of individuals with upper quadrant injuries, including the neck, shoulders, and arms.
Employers, healthcare providers, and rehabilitation specialists involved in the care and management of injured workers are required to file the Canada WCB Functional Examination Record Upper Quadrant.
To fill out the Canada WCB Functional Examination Record Upper Quadrant, providers should accurately record patient information, conduct a thorough assessment of functional abilities, note any limitations, and ensure all sections of the form are completed with relevant findings.
The purpose of the Canada WCB Functional Examination Record Upper Quadrant is to document the functional status of an injured worker, facilitate communication between healthcare providers, and support claims management and rehabilitation planning.
The information that must be reported on the Canada WCB Functional Examination Record Upper Quadrant includes patient demographics, assessment results, range of motion, strength measurements, functional limitations, and any recommendations for further treatment or rehabilitation.
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