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Michigan Amputation Chart (fill-in form)

Category:
Michigan Workers Compensation - Official
State:
Michigan
Control #:
MI-WC-728
Format:
PDF
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Description

Amputation Chart (fill-in form) The Michigan Amputation Chart (fill-in form) is a medical device used to document an amputation or the loss of a limb. It is a form which records the details of the amputation procedure, the site of amputation (level of amputation) and the type of amputation. It also records the patient's demographic information and medical history. The form is used to track the patient's progress following the amputation and to monitor any potential complications. There are two types of Michigan Amputation Chart (fill-in form): The Standard Chart and the Modified Chart. The Standard Chart is used for amputations that occur at or below the level of the knee or elbow and the Modified Chart is used for amputations that occur above the level of the knee or elbow. The information collected in the Michigan Amputation Chart (fill-in form) is important for tracking the patient's progress and for developing a treatment plan.

The Michigan Amputation Chart (fill-in form) is a medical device used to document an amputation or the loss of a limb. It is a form which records the details of the amputation procedure, the site of amputation (level of amputation) and the type of amputation. It also records the patient's demographic information and medical history. The form is used to track the patient's progress following the amputation and to monitor any potential complications. There are two types of Michigan Amputation Chart (fill-in form): The Standard Chart and the Modified Chart. The Standard Chart is used for amputations that occur at or below the level of the knee or elbow and the Modified Chart is used for amputations that occur above the level of the knee or elbow. The information collected in the Michigan Amputation Chart (fill-in form) is important for tracking the patient's progress and for developing a treatment plan.

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