Get Upper Extremity Impairment Evaluation Record Part 1 (hand) - Colorado

Filling out the Upper Extremity Impairment Evaluation Record Part 1 (Hand) is a crucial step in documenting hand impairments for evaluation purposes in Colorado. This guide will provide you with clear and detailed instructions to help you navigate through the form effectively and accurately.

Follow the steps to complete the evaluation record with ease.

1. Click the 'Get Form' button to obtain the Upper Extremity Impairment Evaluation Record Part 1 (Hand) and open it for editing.
2. Enter your personal details in the fields for Name, Age, Occupation, and Diagnosis. Ensure to accurately reflect your current situation.
3. If applicable, indicate any amputation, sensory loss, or other disorders by checking the appropriate boxes. This information helps to provide a complete understanding of your condition.
4. In the section for Record Motion, Ankylosis, and Impairment %, document any relevant impairments according to your assessment. Use the marked levels for accurate documentation.
5. For each digit in the Hand, record the following: motion, abnormal motion, sensory loss, and any other disorders, providing impairment percentages as per your evaluation.
6. Calculate the digit impairment percentages by combining the values entered in previous sections. Ensure these calculations are accurate for the assessment.
7. Complete the Hand Impairment % section by converting the digit impairment percentages listed and combining the results accurately.
8. Review the total hand impairment for all fingers, and calculate the overall upper extremity impairment percentage using the conversion tables provided in the form.
9. Finally, save your changes. You can also choose to download, print, or share the completed form as needed.

Start filling out your Upper Extremity Impairment Evaluation Record Part 1 (Hand) online today!