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Name: ___ Date: ___ UPPER EXTREMITY FUNCTIONAL INDEX We are interest ed in knowing whet her you are having any difficult y at all wit h the acts IIT IES list ed below because of your upper limb problem

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How to fill out form upper extremity functional

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Step 1: Start by reading the instructions on the form.

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Step 2: Fill in your personal information such as name, date of birth, and contact information.

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Step 3: Answer the questions regarding your upper extremity functionality and any limitations you may have.

04

Step 4: Provide any relevant medical history or information that may impact your upper extremity function.

05

Step 5: Review the form for any errors or missing information before submitting it.

Who needs form upper extremity functional?

01

Individuals who have experienced injury or disability affecting their upper extremities.

02

Patients undergoing rehabilitation for upper extremity issues.

03

Healthcare professionals assessing patients' upper extremity function.

04

Individuals applying for disability benefits related to upper extremity impairments.

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What is form upper extremity functional?

Form upper extremity functional is a medical assessment form that evaluates the function of the upper extremities, including the arms, shoulders, and hands.

Who is required to file form upper extremity functional?

Employees who have suffered an injury or illness affecting their upper extremities may be required to file form upper extremity functional.

How to fill out form upper extremity functional?

Form upper extremity functional should be filled out by a qualified healthcare provider who will assess and document the function of the employee's upper extremities.

What is the purpose of form upper extremity functional?

The purpose of form upper extremity functional is to evaluate the impact of an injury or illness on the function of the employee's upper extremities and determine any necessary accommodations or treatment.

What information must be reported on form upper extremity functional?

Form upper extremity functional requires detailed information about the employee's medical history, the nature of the injury or illness, and the results of the functional assessment.

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