Get Basic Hip Evaluation Form

Completing the Basic Hip Evaluation Form online is a crucial step in assessing your hip condition. This guide will walk you through each section of the form, ensuring you provide accurate and relevant information for your evaluation.

Follow the steps to fill out the Basic Hip Evaluation Form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the respective interface.
2. Begin by filling out your personal information, including your name, date, date of birth, and age. Accurate personal details are essential for identification in your evaluation process.
3. Next, navigate to the pain assessment section. Here, indicate the level of pain you experience by selecting one of the options provided, such as 'None', 'Mild', 'Moderate', 'Marked', or 'Totally disabled'. This helps quantify your discomfort.
4. Proceed to the function section. Evaluate your gait by selecting the limp severity that best describes your situation: 'None', 'Slight', 'Moderate', 'Severe', or 'Unable to walk'. This section assesses your mobility.
5. In the support section, indicate the type of walking aids you use, if any. Options may include 'None', 'Walking stick', 'Crutch', or 'Unable to walk'. This information provides insights into your level of independence.
6. The distance walked section asks how far you can walk before experiencing pain. Select the option that accurately represents your ability, ranging from 'Unable to walk' to 'Unlimited'. This is important for understanding your mobility limitations.
7. Next, complete the functional activities section by indicating your ability to perform specific tasks like going up and down stairs, sitting, and using public transport. Choose the option that corresponds to your current capabilities.
8. You will then be asked about the extent of your pain at rest and during activity. Rate your pain on a scale from 1 to 10, with 1 being the least and 10 the most intense. This helps in assessing your pain levels effectively.
9. Indicate the location of your pain and whether it radiates to other areas. Be sure to check all that apply, as multiple locations can indicate different issues.
10. Report any previous hip injuries, treatments, or surgeries you have had. This contextual information is valuable for your medical assessment.
11. Finally, review your entries for accuracy and completeness. Once satisfied, save your changes, download, print, or share the form as needed for your evaluation.

Complete your Basic Hip Evaluation Form online today to ensure you receive the best possible assessment of your hip condition.