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Get IL HFS 3701H 2008-2024

Ng System: Overall W/C Length Overall W/C Width Number of Hours/Day Spent in Wheelchair? WHEELCHAIR SKILLS: (Shown by Trial) PT. IS TOTALLY DEPENDENT FOR MOBILITY YES [ ] NO [ ] Indep Assist Dependent/ Unable N/A Comments Bed ↔ W/C Chair Transfers w/c ↔ Commode Transfers Manual w/c Propulsion: Operate Scooter UE or LE Strength and Arm : Left Right Both Endurance Sufficient to Participate in Foot: Left Right Both ADLs Using Manual Wheelchair Strength, Hand Grip, Balance, Transfer A.

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