Get Gillette Functional Assessment Questionnaire Pdf

Filling out the Gillette Functional Assessment Questionnaire is an important step in evaluating a patient's functional abilities. This guide provides a step-by-step approach for completing the form online, ensuring that all necessary information is captured accurately.

Follow the steps to complete the questionnaire online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient's name in the designated field. Make sure to fill in the first, middle, and last names as required.
3. Fill in the date of birth and account number in their respective fields. Ensure these details are correct for accurate patient identification.
4. Provide the date of the scheduled analysis where indicated. This helps track the patient's assessment timeline.
5. Indicate your relationship to the patient by selecting the appropriate option from the list provided.
6. Report the patient's current grade in school, selecting from choices ranging from 'not in school' to 'college or university.'
7. Address any particular concerns regarding the patient’s walking in the provided section to guide care plans.
8. List any specific goals or expectations you may have for the treatment of the patient to provide clear objectives.
9. Proceed to the medical history section, answering questions regarding seizure disorders, learning issues, and medications. Provide details where necessary.
10. Complete the patient’s birth history by answering questions about weight at birth, pregnancy, and delivery complications.
11. Describe the patient's physical abilities and select the statements that best describe their typical walking abilities.
12. Rate the ease of physical activities the patient can perform and indicate any limitations to walking ability.
13. Indicate if the patient is currently involved in a physical therapy program and provide details about the program.
14. Once all fields are completed, make sure to save your changes, download the filled-out form, print it, or share it as needed.

Complete your Gillette Functional Assessment Questionnaire online to facilitate the evaluation process.