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Date: Name: Number: Boston University Activity Measure Post Acute Care (AMPAC) Basic Mobility Outpatient Short Form Version 05.07.001 Please check the box that reflects your (the patients) best answer.

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How to fill out the Basic_Mobility_AMPAC - Dora Roberts Rehabilitation online

This guide provides a comprehensive overview of how to effectively complete the Basic Mobility AMPAC form used in Dora Roberts Rehabilitation. The following steps will assist you in understanding each section of the form to ensure accurate and efficient documentation.

Follow the steps to effectively complete your form.

  1. Press the ‘Get Form’ button to obtain the form and open it for editing.
  2. Begin filling in the date at the top of the form. Ensure that the date is accurate and up to date.
  3. Enter the name of the individual completing the form in the designated 'Name' field. This should include the full name as it appears on formal documentation.
  4. Input the number associated with the patient or user as prompted on the form, ensuring to provide any necessary identifiers required.
  5. For each question related to mobility, review the provided statements carefully. Select the checkbox that best reflects the individual's level of difficulty in performing the activity, using the following scale: 'Unable', 'A Lot', 'A Little', or 'None'. Ensure that all relevant questions are answered.
  6. For the final portion of the form, calculate and enter the Raw Score and Standardized Score based on the responses provided. Ensure these values reflect the accurate assessment of mobility based on the selected answers.
  7. Once all fields have been completed, you may choose to save your changes, download the form, print it, or share it as necessary for further processing.

Complete your Basic Mobility AMPAC form online today and ensure a smooth rehabilitation process.

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