Get Initial Assessment Lefs Survey Form.pdf

Filling out the Initial Assessment Lefs Survey Form online is a straightforward process that helps healthcare providers assess your lower limb functionality. This guide will help you navigate the form in a clear and supportive manner, ensuring you provide all necessary information accurately.

Follow the steps to complete your assessment form online.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by filling out the patient name and the therapist's name at the top of the form. Enter today’s date accurately.
3. In the 'Initial Assessment' section, review each activity listed carefully. For each statement, indicate the level of difficulty you experience related to your lower limb problem by selecting one of the options provided.
4. For the activities, consider the following options: Extreme difficulty or unable to perform, Quite a bit of difficulty, Moderate difficulty, A little bit of difficulty, and No difficulty. Assign a score from 0 to 4 for each activity based on your experiences.
5. Complete the column totals section briefly summarizing the scores for further evaluation by orthopedic rehab specialists.
6. Enter any relevant diagnosis codes in the designated space, as this information is important for insurance and medical records.
7. Lastly, review your answers for accuracy, then save any changes you have made to the document. You can also download, print, or share the form as needed.

Complete the Initial Assessment Lefs Survey Form online today to aid in your rehabilitation process.