Get Lic Deformity Questionnaire

Filling out the Lic Deformity Questionnaire online can seem daunting, but with this guide, you will navigate each section with confidence. This comprehensive, step-by-step approach is designed to assist you in providing the necessary information accurately and efficiently.

Follow the steps to complete your questionnaire seamlessly.

1. Press the ‘Get Form’ button to access the Lic Deformity Questionnaire and open it in your preferred digital platform.
2. Begin by entering the name of the proponent or life assured in the designated field. This is crucial as it identifies the individual associated with the questionnaire.
3. Proceed to question 1(a). Indicate the cause of the deformity by selecting one of the options: congenital, due to an accident or injury, or due to any underlying disease. For 1(b), specify how long the deformity has been present by providing the relevant date or duration.
4. If the deformity results from an underlying disease, you will need to provide details in section 2. Mention the disease that led to the deformity, when it occurred, and whether its progression is stationary or progressive, along with the date if it’s stationary.
5. In question 3, indicate if the person has control over bowel movements and bladder. Answering this truthfully helps gauge the extent of the impairment.
6. Question 4 asks for specific body parts affected by the deformity and the extent of the disability. Be detailed in your response to ensure a clear understanding.
7. Continue to question 5 to assess if there are any restrictions in movement or function of the limbs. Provide a degree of disability if applicable.
8. In question 6, answer if the individual has a limp, which will contribute to understanding their mobility.
9. For questions 7 and 8, specify if the person can walk or run without aid and if they can squat, sit, and get up properly.
10. Question 9 requires you to state if the affected limb is shorter than the other and specify the measurement in centimeters.
11. In case of deformity due to poliomyelitis, question 10 seeks to know the degree of muscle wasting—mild, moderate, or severe.
12. Question 11 asks how many limbs are affected, while question 12 inquires about any restrictions in finger movement or if any fingers have been removed.
13. In sub-questions (a) and (b) of question 13, evaluate if the person can lift and hold objects without difficulty and whether their grip is firm and strong.
14. Provide your diagnosis of the cause of the disability, along with any reasons for clinical concerns regarding recent deterioration in question 14.
15. Finally, submit any pertinent previous treatment details or special reports, such as x-rays, for review.
16. After completing the questionnaire, ensure all fields are filled accurately. Save your changes, and proceed to download, print, or share the completed document as necessary.

Start filling out your Lic Deformity Questionnaire online now to complete your documentation process efficiently.