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Diagnoses
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symptoms
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what has changed, why now needs
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how far can ambulate
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weight in pounds
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height in inches
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LEFT Arm strength and ROM
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RIGHT Arm strength and ROM
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Left leg strength and ROM
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Right leg strength and ROM
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Cardiopulmonary check all positive
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Patient has (x) coordination to operate WC
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Pt has (x) gait
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gait due to
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BALANCE is (X)
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Why walker,cane or crutches not approp
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Why manual WC not appropr
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why does patient need a new power WC?
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Patient has mental abilities to use power chair
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RX Diagnoses include
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