Neurological and Trauma Impairment Set Version 10
|
|
|
- Mitchell Hopkins
- 8 years ago
- Views:
Transcription
1 Neurological and Trauma Impairment Set Version 10 Admission/Discharge - Neurological + Trauma Impairment Set Version 10 (Please circle reason for assessment) Name: Severity scores - extent to which deficit impacts on function/engagement in rehab Score Impairment Functional impact No: 0 None Normal function 1 Mild Affecting high level function only Date of completion: 2 Moderate Significant limitation, but some useful function / /. 3 Severe Little or no useful function, effectively limiting rehabilitation /Untestable (Circle one) Impairment Type Other type: O Motor O R Hemiparesis b7302 Other: Left upper limb s730 Subscore U O L Hemiparesis b7302 Right upper limb s730 Subscore U O Tetraparesis b7304 Left lower limb s750 Subscore U O Paraparesis b7303 Right lower limb s750 Subscore U O Monoparesis b7301 Trunk s760 Subscore U O Ataxia b760 Motor total score /14 O Tone / joint range (Unknown) O Spasticity b735 Other: O Contractures b710 O Sensation (Untestable) O Somatic (eg touch) b265 Other: O Propioception b260 O Dysaesthesia b279 O Perceptual function (Untestable) O Neglect of body - b180 Other: O Neglect of external space - b156 O Speech and language (Untestable) O Expressive b1671 Other: O Receptive b1670 O Dysarthria b320 O Cognitive speech b1670 O Cognitive function (Untestable) O Consciousness b110 Other: O Orientation b114 O Memory b144 O Attention b140 O Initiation b147 O Executive function b164 eg insight, planning, flexible thought O Behaviour (Unknown) O Verbal aggression d7202 Other: O Physical aggression d7202 O Disinhibition d7202 O Mood (Unknown) O Depression / Low mood b152 Other: O Anxiety b152 O Emotional lability b1521 O Seeing and Vision (Untestable) O Visual field loss b2101 Other: O Uncorrectable acuity b2100 O Double vision b2152 O Hearing (Untestable) O Sensorineural (ICF- no code identified) Other: O Conductive (ICF- no code identified) O Pain (Untestable) O Neuropathic pain b280 Other: O Musculoskeletal pain b280 O Pain due to spasticity b280/b735 O Fatigue (Untestable) O Reduced cardiovascular fitness Other: O Muscle fatiguabiity b740 O Cognitive fatigue (ICF- no code identified) O Seizures (Unknown) O Tonic clonic Other: O Partial complex O Partial simple O focal / myoclonic jerks O Bladder dysfunction (Untestable) O Neuropathic bladder - b620 Other: O Urethral stricture - b620 O Outlet obstrction ( eg prostate)- b620 O Stress incontinence - b620 O Bowel dysfunction (Untestable) O Constipation - b525 Other: O Diarrhoea - b525 UKROC v13.01 Last Updated April 2013
2 Neurological and Trauma Impairment Set Version 10 O Dysregulation - b525 O Skin integrity (Unknown) O Open wounds Other: O Burns O Pressure sores O Vulnerable Scarring O Nutritional status (Unknown) O Overweight Other: O Underweight O Morbid obesity O Substance abuse (Unknown) O Alcohol Other: O Tobacco O Drugs O Fractures Left upper limb s730 Subscore U O Unstable O External fixator O Internal fixatoro Healed Right upper limb s730 Subscore U O Unstable O External fixator O Internal fixatoro Healed Left lower limb s750 Subscore U O Unstable O External fixator O Internal fixatoro Healed Right lower limb s750 Subscore U O Unstable O External fixator O Internal fixatoro Healed Pelvis Subscore U O Unstable O External fixator O Internal fixatoro Healed Spine Subscore U O Unstable O External fixator O Internal fixatoro Healed Skull/facial Subscore U O Unstable O External fixator O Internal fixatoro Healed Ribs Subscore U O Healed Fracture total score /24 O Limb loss Left upper limb Subscore O Stump unhealed O Stump healed Right upper limb Subscore O Stump unhealed O Stump healed Left lower limb Subscore O Stump unhealed O Stump healed Right lower limb Subscore O Stump unhealed O Stump healed total score /12 Other: O Vascular (Unknown) O Ischaemia Other: O Compartment syndrome O Gangrene O Sympathetic storming O Autonomic dysreflexia O Other dysautonomia O Chest/abdo (Unknown) O Haemo/pneuothorax Other: O Cardiac O Lung damage O Liver/Spleen O Renal tract O Comorbid conditions (Unknown) O Diabetes Other: O Ischaemic Heart disease O COPD O Osteoporosis / osteopenia O Heterotopic ossification O Arthritis O Other (Unknown) TOTAL SCORE Range Summary of total scores Neurological Impairment Set Additional Trauma set Motor 14 Bladder 3 Tone 3 Bowels 3 Sensation 3 Skin integrity 3 Perceptual function 3 Nutritional status 3 Speech and language 3 Substance abuse 3 Cognitive 3 Fractures 24 Behaviour 3 Limb loss 12 Mood 3 Vascular 3 Vision 3 Chest/abdo injuries 3 Hearing 3 Co-morbid conditions 3 Pain 3 Other 3 Fatigue 3 Total 63 Seizures 3 Total 50 UKROC v13.01 Last Updated April 2013
3 Neurological Impairment Set Severity - extent to which deficit impacts on function / engagement in rehabilitation Impairment Type Score Level Descriptor O Motor control O R Hemiparesis b7302 Score range O b730 - Muscle power f'n O L Hemiparesis b None No weakness/loss of motor control/coordination O b760 - co-ordination O Tetraparesis b Mild Affecting higher level motor control only of voluntary movement O Paraparesis b Moderate Significant impact on function but some useful active movement O Monoparesis b Severe Severe loss of motor control, with little or no active movemnt O Ataxia b760 Separated scores Left upper limb s730 Right upper limb s730 Left lower limb s750 Right lower limb s750 Trunk s760 Total Motor score / 14 O Tone and joint range O Spasticity b735 0 None No spasticity / contractures O b735 Muscle tone f'n O Contractures b710 1 Mild Mild tone problems - can achieve full range of movement O b710 joint mobility 2 Moderate Significant significant spasticity with mild restriction of some joint range (1-2 joints only) 3 Severe Severe spasticity/contracture with marked restriction of joint range - limiting function O Sensation O Somatic (eg touch) b265 0 None No dysaesthesia, loss of sensation or joint position sense O b260 / 265 sensory f'n O Propioception b260 1 Mild Mild or patchy loss - minimal interferance with sensory function O b279 additional sensory f'n O Dysaesthesia b279 2 Moderate Partial sensory loss with significant impact on ability to feel the limb and where it is 3 Severe Complete / near-complete less of sensation (all modalities) in one or more limbs O Perceptual function O Neglect of body b180 0 None No negect of body or external space (ie does not ignore body parts or bump into things) O b180 - experience of self O Neglect of external space b156 1 Mild Mild neglect, but compensates effectively - minimal interference with function O b156 - perceptual f'n 2 Moderate Bumps into things or ignores body parts some of the time with significant impact on function 3 Severe Total neglect of body part or field effectively limiting function / rehabilitation O Speech and Language O Expressive b None No deficit in expression / comprehension or articulation of language O b167 - language f'n O Receptive b Mild Mild deficit affecting high level communication only O b320 - articulation f'n O Dysarthria b320 2 Moderate Moderate deficit with significant impact on functional communication / listener burden O Cognitive speech b Severe Severe deficit - communication through language effectively not possible O Cognitive function O Consciousness b110 0 None No cognitive deficit O b110/114 - consciousness O Orientation b114 1 Mild Mild deficit affecting higher level cognitive function only O b140 /144 / 147 mental f'ns O Memory b144 2 Moderate Moderate deficit with significant impact on carryover and engagement in rehabilitation O b164 Higher cognitive f'n O Attention b140 3 Severe Severe cognitive deficit effectively limiting carryover and engagement in rehabilitation O Initiation b147 O Executive function b164 eg insight, planning, flexible thought UK ROC v13.01 Last Updated April 2013
4 O Behaviour O Verbal aggression d None No problems with aggression or disinhibition O d720 Interpersonal interaction O Physical aggression d Mild Occasional mild outbursts/ disinhibition, with minimal impact on function / rehabilitation O Disinhibition d Moderate Moderate behavioural problems with significant impact/ interference with rehabilitation 3 Severe Severe behaviours / hitting/ biting scratching etc which effectively limit rehabilitation O Mood O Depression / Low mood 0 None No mood disturbance - depressive or anxiety O b152 emotional f'n O Anxiety 1 Mild Mild mood problems not interfering with daily function O Emotional lability b Moderate Significant mood disturbance with some impact on function / engagement in rehabilitation 3 Severe Severe mood disorder effectively limiting engagement in rehab O Seeing and Vision O Visual field loss b None No visual deficit O b210 seeing f'n O Uncorrectable acuity b Mild Mild visual deficit correctable with compensatory techniques O b215 eye movements O Double vision b Moderate Moderate visual disturbance with significant limitation on function (partially sighted) 3 Severe Severe - effectively blind - little or no useful vision O Hearing O Sensorineural (ICF?? ) 0 None No hearing deficit O b230 hearig f'n O Conductive (ICF?? ) 1 Mild Mild hearing deficit correctable with hearing aid 2 Moderate Moderate hearing disturbance with significant limitation on function (partially deaf) 3 Severe Severe - effectively deaf - little or no useful hearing O Pain O Neuropathic pain b280 0 None No pain O b280 pain O Musculoskeletal pain b280 1 Mild Mild pain, easily controlled with little impact on function / rehabilitation O Pain due to spasticity b280/b735 2 Moderate Moderate pain, imcompletely controlled - significant inpact on function/ rehabilitation 3 Severe Severe pain - effectively limits function / engagment in rehabilitation O Fatigue / stamina O Reduced cardiovascular fitness 0 None No fatigue O b740 muscle endurance O Muscle fatiguabiity b740 1 Mild Mild fatigue, easily controlled through paciing with little impact on function / rehabilitation O Cognitive fatigue (ICF?? ) 2 Moderate Moderate fatigue, incompletely controlled - significant interference with function/ rehabilitation 3 Severe Severe - effectively limits function / engagment in rehabilitation O Seizures O Seizures (ICF?? ) 0 None No seizures Seizures ( no ICF code) 1 Minimal Occasional mid self-limiting seizures - little interference with function / rehabilitation 2 Moderate Moderately frequent seizures - incompletely controlled 3 Severe Very frequent or severe seizures (eg episodes of status epilepticus) O Bladder Dysfunction O Neuropathic bladder - b620 0 None No bladder dysfunction O b620 Bladder f'n O Urethral stricture - b620 1 Minimal Occasional incontinence /urinary frequency - little interference with daily function / rehabilitation O Outlet obstruction ( eg prostate)- b620 2 Moderate Moderate incontinence / urinary frequency - significant interference with function / rehabilitation O Stress incontinence - b620 3 Severe Frequent or severe incontinence - effectively limits function / rehabilitation O Bowel Dysfunction Constipation - b525 0 None No bowel dysfunction O b525 Bowel f'n Diarrhoea - b525 1 Minimal Occasional incontinence / frequency - little interference with function / rehabilitation Dysregulation - b525 2 Moderate Moderately incontinence / frequency - significant interference with function / rehabilitation UK ROC v Severe Frequent or severe incontinence - effectively limits function / rehabilitation Last Updated April 2013
5 U Untestable O Skin integrity O Open wounds 0 None Skin fully intact O b820 repair functions of skin O Burns 1 Minimal Minimal skin wound /scarring - little interference with function / rehabilitation O Pressure sores 2 Moderate Moderate healing skin wound - with significant interference with function / rrehabilitation O Vulnerable Scarring 3 Marked Severe skin wound/compromised healing - effectively limits function / rehabilitation O Nutritional status O Overweight 0 None Normal weight and nutrition O b530 Weight maintenance f'no Underweight 1 Minimal Mildly over/underweight - little interference with function / rehabilitation O Morbid obesity 2 Moderate Moderately over/underweight - significant interference with function /rehabilitation 3 Severe Severely over/underweight - effectively limits function / rehabilitation O Substance abuse O Alcohol 0 None No substance abuse No ICF code O Tobacco 1 Minimal Occasional use of substances - little interference with function / rehab O Drugs 2 Moderate Moderate use of substances / addiction - significant interference with function / rehabilitation 3 Severe Frequent use / severe addition - effectively limits function / engagement in rehabilitation O Fractures Score range O s700 structures related to movement 0 None No fractures 1 Mild Fracture affecting only higher level function of that body part 2 Moderate Moderately severe fracture(s) causing significant impact on function (eg partial weight-bearing / limb use) 3 Severe Severe fracture(s) causing significant impact on function, (eg non weight-bearing / non-use of limb) Separated scores Left upper limb s730 Right upper limb s730 Left lower limb s750 Right lower limb s750 Pelvis s740 Spine s760 Skull/facial s710 Ribs s4302 Total fracture score / 24 O Limb loss Score range O s730 Upper extremity 0 None No limb loss O s730 Lower extremity 1 Mild Minor loss affecting only higher level function of that body part ( eg 1-2 digits) 2 Moderate Distal half limb loss with significant impact on function, but still some functional use in that limb 3 Severe Proximal half limb loss with effectively no functional use of that limb Separated scores Left upper limb s730 O Stump unhealed O Stump healed Right upper limb s730 O Stump unhealed O Stump healed Left lower limb s750 O Stump unhealed O Stump healed Right lower limb s750 O Stump unhealed O Stump healed Total limb lossscore / 12 UK ROC v13.01 Last Updated April 2013
6 O Vascular O Ischaemia 0 None No vascular impairment O b415 Blood vessel f'n O Compartment syndrome 1 Mild Mild vascular problems - little interference with function / rehabilitation O Gangrene 2 Moderate Significant vascular disturbance - with significant interference with function / rehabilitation O Sympathetic storming 3 Severe Severe vascular disorder - effectively limiting function / rehabilitation O Autonomic dysreflexia O Other dysautonomia O Chest abdo O Haemo/pneumothorax 0 None No chest/abdominal injury O Cardiac b410 1 Mild Mild chest/abdo injury - little interference with function / rehabilitation O Lung damage b440 2 Moderate Significant chest/abdo injury - with significant interference with function / rehabilitation O Liver b560 3 Severe Severe chest/abdo injury - effectively limits function / rehabilitation O Spleen s4203 O Renal tract b610 O Comorbidity O Diabetes 0 None No co-morbid conditions that interfere with function / rehabilitation O Ischaemic Heart disease 1 Minimal Minimal co-morbid condition - affecting only higher function - little limitation of engagement in rehabilitation O COPD 2 Moderate Moderate co-morbid condition - with significant interference with function / engagement in rehabilitation O Arthritis 3 Marked Severe co-morbid condition - effectively limiting function / engagement in rehabilitation O Mental health condition O Other 0 None No other conditions that interfere with function / rehabilitation 1 Minimal Minimal other condition - affecting only higher function - little limitation of rehabilitation 2 Moderate Moderate other condition - with significant interference with function / rehabilitation 3 Marked Severe other condition - effectively limits function / rehabilitation UK ROC v13.01 Last Updated April 2013
Closed Automobile Insurance Third Party Liability Bodily Injury Claim Study in Ontario
Page 1 Closed Automobile Insurance Third Party Liability Bodily Injury Claim Study in Ontario Injury Descriptions Developed from Newfoundland claim study injury definitions No injury Death Psychological
Spinal Cord Injury Education. An Overview for Patients, Families, and Caregivers
Spinal Cord Injury Education An Overview for Patients, Families, and Caregivers Spinal Cord Anatomy A major component of the Central Nervous System (CNS) It is 15 to 16 inches long, and weighs 1 to 2 ounces
Chapter 4: Eligibility Categories
23 Chapter 4: Eligibility Categories In this chapter you will: learn the different special education categories 24 IDEA lists different disability categories under which children may be eligible for services.
The Thirteen Special Education Classifications. Part 200 Regulations of the Commissioner of Education, Section 4401(1)
The Thirteen Special Education Classifications Part 200 Regulations of the Commissioner of Education, Section 4401(1) Student With a Disability: A student as defined in section 4401(1), who has not attained
O: Gerontology Nursing
O: Gerontology Nursing Alberta Licensed Practical Nurses Competency Profile 145 Competency: O-1 Aging Process and Health Problems O-1-1 O-1-2 O-1-3 O-1-4 O-1-5 O-1-6 Demonstrate knowledge of effects of
Categories of Exceptionality and Definitions
7. CATEGORIES and DEFINITIONS of EXCEPTIONALITIES Purpose of the standard To provide the ministry with details of the categories and definitions of exceptionalities available to the public, including parents
3030. Eligibility Criteria.
3030. Eligibility Criteria. 5 CA ADC 3030BARCLAYS OFFICIAL CALIFORNIA CODE OF REGULATIONS Barclays Official California Code of Regulations Currentness Title 5. Education Division 1. California Department
St. Luke s MS Center New Patient Questionnaire. Name: Date: Birth date: Right or Left handed? Who is your Primary Doctor?
St. Luke s MS Center New Patient Questionnaire Name: Date: Birth date: Right or Left handed? Who is your Primary Doctor? Who referred you to the MS Center? List any other doctors you see: Reason you have
Dallas Neurosurgical and Spine Associates, P.A Patient Health History
Dallas Neurosurgical and Spine Associates, P.A Patient Health History DOB: Date: Reason for your visit (Chief complaint): Past Medical History Please check corresponding box if you have ever had any of
6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S.
High Prevalence and Incidence Prevalence 85% of Americans will experience low back pain at some time in their life. Incidence 5% annual Timothy C. Shen, M.D. Physical Medicine and Rehabilitation Sub-specialty
EMOTIONAL AND BEHAVIOURAL CONSEQUENCES OF HEAD INJURY
Traumatic brain injury EMOTIONAL AND BEHAVIOURAL CONSEQUENCES OF HEAD INJURY Traumatic brain injury (TBI) is a common neurological condition that can have significant emotional and cognitive consequences.
Coding and Documentation in Practice
Coding and Documentation in Practice Great Exam Documentation By: Kathy Mills Chang Kathy Mills Chang is a Certified Medical Compliance Expert, Reimbursement Consultant, Medicare Specialist, and a Documentation
Documentation Requirements ADHD
Documentation Requirements ADHD Attention Deficit Hyperactivity Disorder (ADHD) is considered a neurobiological disability that interferes with a person s ability to sustain attention, focus on a task
Substandard Underwriting Structured Settlements
Substandard Underwriting Structured Settlements Structures 101-Back to Basics February 20-22, 2013 Las Vegas, Nevada Rosemary Brindamour BSN CSSC Chief Medical Underwriter Structured Settlement Underwriting
MOTOR VEHICLE ACCIDENT QUESTIONNAIRE
MOTOR VEHICLE ACCIDENT QUESTIONNAIRE Thank you in advance for taking the time to complete this form, this will help us to better assess all of your pain concerns and provide you with the best treatment.
NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.
Rehabilitation during the patient s critical care stay bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online.
Range of Injury Scale Values
Range of Injury Scale Values Civil Liability Regulations 2014 SCHEDULE 4 Range of Injury Scale Values (summary) Item Injury ISV Range Part 1-Central Nervous System and Head Injuries 1 Quadriplegia 75 100
Task 1: Use the nursing process to incorporate models and theories into nursing practice.
CRRN examination content outline Below are the domains with related tasks and knowledge and skill statements. Beginning in 2014, renewing CRRNs will be required to validate that each professional development
Comprehensive Special Education Plan. Programs and Services for Students with Disabilities
Comprehensive Special Education Plan Programs and Services for Students with Disabilities The Pupil Personnel Services of the Corning-Painted Post Area School District is dedicated to work collaboratively
JAMES PETROS, M.D., INC. PHONE: (408) 528-8833 FAX: (408) 528-8557
FIGHTING PAIN. TOUCHING LIVES. JAMES PETROS, M.D., INC. PHONE: (408) 528-8833 FAX: (408) 528-8557 Personal Information Emergency Contact Today s Date: Name: Patient: Realtionship: Birth Date: Age: Sex:
How To Become A Physio And Rehabilitation Medicine Specialist
EUROPEAN BOARD OF PHYSICAL AND REHABILITATION MEDICINE LOGBOOK EUROPEAN UNION OF MEDICAL SPECIALISTS UEMS IDENTIFICATION... 2 INSTRUCTIONS FOR USE... 3 THE TRAINING COURSE... 3 TRAINING PROGRAMME... 4
SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D]
![SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D]](/thumbs/27/9667060.jpg "SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D]")
SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] I. Definitions: Detoxification is the process of interrupting the momentum of compulsive drug and/or alcohol use in an individual
PATIENT HISTORY FORM
PATIENT HISTORY FORM If you are new to the office, have not been seen in over one (1) year, or are returning for a new problem, please complete this form in full. If there have been any changes since your
Traumatic Brain Injury and Incarceration. Objectives. Traumatic Brain Injury. Which came first, the injury or the behavior?
Traumatic Brain Injury and Incarceration Which came first, the injury or the behavior? Barbara Burchell Curtis RN, MSN Objectives Upon completion of discussion, participants should be able to Describe
Fact Sheet. Queensland Spinal Cord Injuries Service. Pain Management Following Spinal Cord Injury for Health Professionals
Pain Management Following Injury for Health Professionals and Introduction Pain is a common problem following SCI. In the case where a person with SCI does have pain, there are treatments available that
How to Do the EDSS EDSS
How to Do the EDSS Stephen S. Kamin, MD New Jersey Medical School EDSS Expanded Disability Status Scale Devised by John Kurtzke in the 1960s and modified in the 1980s 1 EDSS Advantages Widely used Provides
Rehabilitation Integrated Transition Tracking System (RITTS)
Rehab Criteria The patient must have a physical impairment requiring rehabilitation OR have a known cognitive impairment requiring ongoing rehabilitation support or services. The patient is medically stable:
Quality Measures for Long-stay Residents Percent of residents whose need for help with daily activities has increased.
Quality Measures for Long-stay Residents Percent of residents whose need for help with daily activities has increased. This graph shows the percent of residents whose need for help doing basic daily tasks
DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource
E-Resource March, 2015 DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource Depression affects approximately 20% of the general population
Disability Evaluation Under Social Security
Disability Evaluation Under Social Security Revised Medical Criteria for Evaluating Endocrine Disorders Effective June 7, 2011 Why a Revision? Social Security revisions reflect: SSA s adjudicative experience.
Developmental delay and Cerebral palsy. Present the differential diagnosis of developmental delay.
Developmental delay and Cerebral palsy objectives 1. developmental delay Define developmental delay Etiologies of developmental delay Present the differential diagnosis of developmental delay. 2. cerebral
LIVING WELL An Integrative Approach to Wellness with MS Member Application
LIVING WELL An Integrative Approach to Wellness with MS Member Application Name: Date: Address: City: State: Zip: Phone: Home Work Cell E-mail address: Fax: Gender: Male Female Handedness: Left Right Both
NEURO-OPHTHALMIC QUESTIONNAIRE NAME: AGE: DATE OF EXAM: CHART #: (Office Use Only)
PAGE 1 NEURO-OPHTHALMIC QUESTIONNAIRE NAME: AGE: DATE OF EXAM: CHART #: (Office Use Only) 1. What is the main problem that you are having? (If additional space is required, please use the back of this
Myelopathy Paresis and Paralysis in Cats
Myelopathy Paresis and Paralysis in Cats (Disorder of the Spinal Cord Leading to Weakness and Paralysis in Cats) Basics OVERVIEW Myelopathy any disorder or disease affecting the spinal cord; a myelopathy
Evidence-Based Practice for Public Health Identified Knowledge Domains of Public Health
1 Biostatistics Statistical Methods & Theory Evidence-Based Practice for Public Health Identified Knowledge Domains of Public Health General Public Health Epidemiology Risk Assessment Population-Based
New Patient Evaluation
What area hurts you the most? (Please choose one) When did this pain start? Neck Other: Back How did this pain start? How often do you experience this pain? Describe what this pain feels like. What makes
Cerebral Palsy: Intervention Methods for Young Children. Emma Zercher. San Francisco State University
RUNNING HEAD: Cerebral Palsy & Intervention Methods Cerebral Palsy & Intervention Methods, 1 Cerebral Palsy: Intervention Methods for Young Children Emma Zercher San Francisco State University May 21,
Stroke Rehabilitation - Evidence Based Practice
Stroke Rehabilitation - Evidence Based Practice Section 1 1) What percent of stroke patients are left with moderate functional impairment? a) 25% b) 40% c) 55% d) 70% 2) Which is not a component of the
NICE: REHABILITATION AFTER STROKE GUIDELINE. Sue Thelwell Stroke Services Co-ordinator UHCW NHS Trust
NICE: REHABILITATION AFTER STROKE GUIDELINE Sue Thelwell Stroke Services Co-ordinator UHCW NHS Trust Content About me! NICE Rehabilitation after Stroke to include background, remit and scope, guideline
FAIRBANKS PHYSICAL THERAPY
REGISTRATION PAPERWORK CHECKLIST If you wish, you can save time and simplify the registration process by completing the registration paperwork before you arrive. This checklist will help make sure you
How To Treat An Elderly Patient
1. Introduction/ Getting to know our Seniors a. Identify common concepts and key terms used when discussing geriatrics b. Distinguish between different venues of senior residence c. Advocate the necessity
Meeting the Needs of Aging Persons. Aging in Individuals with a
Meeting the Needs of Aging Persons with Developmental Disabilities Cross Network Collaboration for Florida Aging in Individuals with a Developmental Disability Module 3 Based on ADRC training developed
Cardiff Health Check for People with a Learning Disability.
Cardiff Health Check for People with a Learning Disability. Date Marital status Name Ethnic origin Principal carer Age Sex Address Weight (kg/stone).. Blood Pressure Smoke (per day). Height (meters /feet)
Continuing Professional Development for Registered and Enrolled Nurses
Continuing Professional Development for Registered and Enrolled Nurses Contents Introduction: Aged Care Learning Solutions CPD Solution 0-04 Learning Plans and Catalogue CPD Solution Resources Learning
Normal Age Related Changes and Developmental Disability
Normal and Developmental Disability Excerpts From: Growing Older with A Developmental Disability: Physical and Cognitive Changes and Their Implications. University of Illinois at Chicago VISION: Changes
Adult Information Form Page 1
Adult Information Form Page 1 Client Name: Age: DOB: Date: Address: City: State: Zip: Home Phone: ( ) OK to leave message? Yes No Work Phone: ( ) OK to leave message? Yes No Current Employer (or school
ORTHOPAEDIC SPINE PAIN QUESTIONNAIRE
ORTHOPAEDIC SPINE PAIN QUESTIONNAIRE NAME: DATE: ADDRESS: AGE: TELEPHONE#: RELIGION: OCCUPATION: REFERRED BY WHOM: NEAREST FRIEND/RELATIVE: TELEPHONE#: ADDRESS: PLEASE EXPLAIN WHY YOU HAVE COME TO SEE
Limited Pay Policy (L-222B) - Underwriting Guidelines
Limited Pay Policy (L-222B) - Underwriting Guidelines 1 Addiction/Abuser Drug - Past or Present Presently Recovered - AA for last 2 years 2 Aids 3 Alcoholic Presently Recovered - AA for last 2 years 4
New perception of disability including cognition, fatigue, pain and other impairments related to MS
New perception of disability including cognition, fatigue, pain and other impairments related to MS Diego Cadavid, MD Director, MS Clinical Development Biogen Idec 1 Need for clarity on terminology for
REHABILITATION SERVICES
REHABILITATION SERVICES Table of Contents GENERAL... 2 TERMS AND ABBREVIATIONS... 2 PRIOR AUTHORIZATION REQUIREMENTS FOR MEDICAID REIMBURSEMENT OF INPATIENT REHABILITATION SERVICES (Updated 4/1/11)...
NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.
Rehabilitation for movement difficulties after stroke bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online.
INTERPROFESSIONAL LEARNING OBJECTIVES FOR STROKE CARE INTRODUCTION
INTERPROFESSIONAL LEARNING OBJECTIVES FOR STROKE CARE INTRODUCTION Supporting Interprofessional Education through Shared Learning Opportunities APRIL 2007 Interprofessional Learning Objectives for Stroke
Multiple Sclerosis (MS)
Multiple Sclerosis (MS) Purpose/Goal: Care partners will have an understanding of Multiple Sclerosis and will demonstrate safety and promote independence while providing care to the client with MS. Introduction
Delirium. The signs of delirium are managed by treating the underlying cause of the medical condition causing the delirium.
Delirium Introduction Delirium is a complex symptom where a person becomes confused and shows significant changes in behavior and mental state. Signs of delirium include problems with attention and awareness,
Full name DOB Age Address Email Phone numbers (H) (W) (C) Emergency contact Phone
DEMOGRAPHIC INFORMATION Full name DOB Age Address Email Phone numbers (H) (W) (C) Emergency contact Phone CARE INFORMATION Primary care physician: Address Phone Fax Referring physician: Specialty Address
RESIDENT ASSESSMENT TOOL
RESIDENT ASSESSMENT TOOL To be completed by a physician, certified nurse practitioner, registered nurse, or physician assistant within 30 days prior to admission, at least annually, & within 48 hours after
Case: Cerebral Palsy
Case: Cerebral Palsy A.W. is a 48 y.o. AA female with diplegic Cerebral Palsy(CP) Dysphagia, coughing, with solid foods X 3 mo. Vague generalized abdominal pain intermittently, 3 lb wt loss Seizure disorder
Instruments Available for Use in Assessment Center
Instruments Available for Use in Assessment Center The Assessment Center Instrument Library includes instruments from PROMIS, Neuro QoL, NIH Toolbox and Health LiTT. All instruments are available for use
Bladder and Bowel Assessment Ann Yates Director of Continence Services. 18/07/2008 Cardiff and Vale NHS Trust
Bladder and Bowel Assessment Ann Yates Director of Continence Services Types of continence problems Bladder Stress incontinence Urgency and urge Incontinence Mixed incontinence Obstructive incontinence
Musculoskeletal System
CHAPTER 3 Impact of SCI on the Musculoskeletal System Voluntary movement of the body is dependent on a number of systems. These include: The brain initiates the movement and receives feedback to assess
Falls Risk Assessment: A Literature Review. The purpose of this literature review is to determine falls risk among elderly individuals and
Falls Risk Assessment: A Literature Review Purpose The purpose of this literature review is to determine falls risk among elderly individuals and identify the most common causes of falls. Also included
Work with vibrating machines Health hazards:
Work with vibrating machines Health hazards: Hand-arm vibration syndrome Vibration-related upper extremity disorders Work-related musculoskeletal disorders Stress-related health effects Noise-related hearing
Women s Continence and Pelvic Health Center
Women s Continence and Pelvic Health Center Committed to Caring 580-590 Court Street Keene, New Hampshire 03431 (603) 354-5454 Ext. 6643 URINARY INCONTINENCE QUESTIONNAIRE The purpose of this questionnaire
NORTHERN EDGE PHYSICAL THERAPY
REGISTRATION PAPERWORK CHECKLIST In order to make registration simple and quick, please use this checklist to make sure you have provided all necessary information and signatures. The process, including
Introduction. What is syncope?
Syncope Introduction What is syncope? Syncope (SING-kuh-pee) is a medical term for fainting. When you faint, your brain is not receiving enough blood and oxygen, so you lose consciousness temporarily.
How To Write A Recipe Card
Joanne R. Festa, PhD (PLEASE PRINT) NAME: DATE OF BIRTH: NEUROPSYCHOLOGY INITIAL VISIT DATE: AGE: Do you have any areas of concern about your cognitive functioning? (i.e., problems with memory, attention,
Transmittal 55 Date: MAY 5, 2006. SUBJECT: Changes Conforming to CR3648 for Therapy Services
CMS Manual System Pub 100-03 Medicare National Coverage Determinations Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 55 Date: MAY 5, 2006 Change
TRAUMATIC BRAIN INJURY (TBI) According to the IDEA, (2004), traumatic brain injury is defined by as:
TRAUMATIC BRAIN INJURY (TBI) DEFINITION: According to the IDEA, (2004), traumatic brain injury is defined by as: An acquired injury to the brain caused by an external physical force, resulting in total
APPENDIX A GLOSSARY OF TERMS AND ABBREVIATIONS
APPENDIX A GLOSSARY OF TERMS AND ABBREVIATIONS GLOSSARY OF TERMS AND ABBREVIATIONS Special Education Terms/Legal Terms Annual Goals Educational performance to be achieved by a student within one year.
Recommended Geropsychiatric Competency Enhancements for Nurse Practitioners Who Provide Care to Older Adults but are not Geriatric Specialists
Recommended Geropsychiatric Competency Enhancements for Nurse Practitioners Who Provide Care to Older Adults but are not Geriatric Specialists These recommended competency enhancement statements are not
Interval: [ ] Baseline [ ] 2 hours post treatment [ ] 24 hours post onset of symptoms ±20 minutes [ ] 7-10 days [ ] 3 months [ ] Other ( )
![Interval: [ ] Baseline [ ] 2 hours post treatment [ ] 24 hours post onset of symptoms ±20 minutes [ ] 7-10 days [ ] 3 months [ ] Other ( )](/thumbs/29/13263233.jpg "Interval: [ ] Baseline [ ] 2 hours post treatment [ ] 24 hours post onset of symptoms ±20 minutes [ ] 7-10 days [ ] 3 months [ ] Other ( )")
Patient Identification. - - Pt. Date of Birth / / Hospital ( - ) Date of Exam / / Interval: [ ] Baseline [ ] 2 hours post treatment [ ] 24 hours post onset of symptoms ±20 minutes [ ] 7-10 days [ ] 3 months
Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice
Dr IM Joubert Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice for any reason had either an at-risk pattern
Disability Evaluation Under Social Security
Disability Evaluation Under Social Security *14.09 Inflammatory arthritis. As described in 14.00D6. With: A. Persistent inflammation or persistent deformity of: 1. One or more major peripheral weight-bearing
Traumatic injuries SPINAL CORD. Causes of Traumatic SCI SYMPTOMS. Spinal Cord trauma can be caused by:
Traumatic injuries SPINAL CORD Jennie Trkulja RN, BScN, ENC (c) Causes of Traumatic SCI Spinal Cord trauma can be caused by: MVC (most injuries) Gunshots Falls Stabbings Assaults Industrial accidents Sports
75-09.1-08-02. Program criteria. A social detoxi cation program must provide:
CHAPTER 75-09.1-08 SOCIAL DETOXIFICATION ASAM LEVEL III.2-D Section 75-09.1-08-01 De nitions 75-09.1-08-02 Program Criteria 75-09.1-08-03 Provider Criteria 75-09.1-08-04 Admission and Continued Stay Criteria
Drug and Alcohol Abuse Prevention Program
Drug and Alcohol Abuse Prevention Program of Bethany Global University Bethany Global University (BGU) has adopted the following policy in compliance with the Drug Free Workplace Act of 1988 and the subsequent
Patient Information Form Pain Management Center at Phoebe
Patient Information Form Pain Management Center at Phoebe Please complete the following form, so that we may facilitate your visit Occupation: or (circle) Retired, Disabled Homemaker, Full time student
DISABILITY-RELATED DEFINITIONS
DISABILITY-RELATED DEFINITIONS 1. The Americans with Disabilities Act (ADA) of 1990 is a civil rights law, which makes it unlawful to discriminate on the basis of disability. It covers employment in the
Nursing Needs Assessment
Nursing Needs Assessment AM/016 PATIENT NAME HOME ADDRE GP & ADDRE DOB IC / HOPITAL NMBER / RECORD NMBER CRRENT LOCATION e.g. Ward, Care Home AEMENT REETED BY NAME & ADDRE OF NRING HO,E PLACEMENT DATE
SAM KARAS ACUTE REHABILITATION CENTER
SAM KARAS ACUTE REHABILITATION CENTER 1 MEDICAL CARE Sam Karas Acute Rehabilitation The Sam Karas Acute Rehabilitation Center is a comprehensive and interdisciplinary inpatient unit. Medical care is directed
Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis
Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis Methodology: 8 respondents The measures are incorporated into one of four sections: Highly
Hospital ID: SS ID: NHS No: NI No: Surname: Forename: D.O.B:
FUNDED NURSING CARE ASSESSMENT Overview Assessment Please attach demographic information form Hospital ID: SS ID: NHS No: NI No: Surname: Forename: : Date of Assessment Location of Assessment: When assessing
REHABILITATION STANDARD: COMMUNICATION
REHABILITATION STANDARD: COMMUNICATION Residents of Vancouver Island Health Authority (VIHA) will have reasonable access to consistent, integrated, measurable, evidence based rehabilitation services. This
Spine Care Centre (SCC) protocols for Multiple Sclerosis Update 1 August 2015
Spine Care Centre (SCC) protocols for Multiple Sclerosis Update 1 August 2015 Introduction Multiple sclerosis (MS) affects nerves in the brain and spinal cord, causing a wide range of symptoms including
Steps to getting a diagnosis: Finding out if it s Alzheimer s Disease.
Steps to getting a diagnosis: Finding out if it s Alzheimer s Disease. Memory loss and changes in mood and behavior are some signs that you or a family member may have Alzheimer s disease. If you have
MEDICAL HISTORY AND SCREENING FORM
MEDICAL HISTORY AND SCREENING FORM The purpose of preventive exams is to screen for potential health problems and provide education to promote optimal health. It is best practice for chronic health problems
Cerebral Palsy. In order to function, the brain needs a continuous supply of oxygen.
Cerebral Palsy Introduction Cerebral palsy, or CP, can cause serious neurological symptoms in children. Up to 5000 children in the United States are diagnosed with cerebral palsy every year. This reference
ARTICLE #1 PLEASE RETURN AT THE END OF THE HOUR
ARTICLE #1 PLEASE RETURN AT THE END OF THE HOUR Alcoholism By Mayo Clinic staff Original Article: http://www.mayoclinic.com/health/alcoholism/ds00340 Definition Alcoholism is a chronic and often progressive
Medical Surgical Nursing (Elsevier)
1 of 6 I. The Musculoskeletal System Medical Surgical Nursing (Elsevier) 1. Med/Surg: Musculoskeletal System: The Comprehensive Health History 2. Med/Surg: Musculoskeletal System: A Nursing Approach to
Emory Eye Center New Patient Questionnaire
Patient Name: Date: Current Address: Current Phone: Date of Birth: Primary Care Physician: Referring Physician: (First & Last Name) (First & Last Name) Pharmacy Name: Phone #: ( ) Please answer all questions
LOW T NATION TESTOSTERONE INTAKE FORM NAME: DATE: ADDRESS: CITY: STATE: ZIP: CELL #: HOME #: SOC SECURITY #: DATE OF BIRTH:
LOW T NATION TESTOSTERONE INTAKE FORM NAME: DATE: ADDRESS: CITY: STATE: ZIP: CELL #: HOME #: SOC SECURITY #: DATE OF BIRTH: DRIVERS LICENSE NUMBER: STATE: EMAIL ADDRESS: MARITAL STATUS: ( ) SINGLE ( )
NEUROSURGERY SERVICES AT APD LOCATED AT UPPER VALLEY MEDICAL GROUP 106 Hanover Street, Lebanon, NH 03766 Phone: 603.448.0447 Fax: 603.448.
DATE NEUROSURGERY SERVICES AT APD LOCATED AT UPPER VALLEY MEDICAL GROUP 106 Hanover Street, Lebanon, NH 03766 Phone: 603.448.0447 Fax: 603.448.0019 Joseph M. Phillips, M.D., Ph.D. Board Certified in Pain
Acknowledgement of Receipt of Notice of Privacy Practices
Acknowledgement of Receipt of Notice of Privacy Practices **You May Refuse to Sign This Acknowledgement** I,, have received a copy of this office s Notice of Privacy Practices. Signature For Office Use
Height FT IN Weight Married? Y / N Employed? Y / N
Name Patient # (PLEASE PRINT) Signature Date Height FT IN Weight Married? Y / N Employed? Y / N Previous Illnesses: Check all that apply AIDS, HIV, STD Epilepsy Pacemaker Alcoholism Eye/vision problems
Facilitating the Self-Management of Spinal Cord Injury
Facilitating the Self-Management of Spinal Cord Injury Michelle A. Meade, Ph.D. University of Michigan Department of Physical Medicine & Rehabilitation Center for Managing Chronic Disease mameade@umich.edu
The insurance company checked above (Company) is responsible for the obligation and payment of benefits under any policy that it may issue.
American International Life Assurance Company of New York* Home Office: 80 Pine Street, New York, NY 10005 The United States Life Insurance Company in the City of New York* Home Office: 830 Third Avenue,
DRIVER REHABILITATION OVERVIEW
DRIVER REHABILITATION OVERVIEW What is included in a Driving Evaluation? The purpose of the evaluation is to determine if the individual s medical condition, medications, functional limitations and/ or
PATIENT INFORMATION INSURANCE INFORMATION
(mm/dd/yyyy): Have you been to Physicians Urgent Care before? Yes No Arrival Time: If yes, when? Is this a follow-up to a previous visit: Yes No PATIENT INFORMATION Patient s First Name: Middle Name: Last
Acute Low Back Pain. North American Spine Society Public Education Series
Acute Low Back Pain North American Spine Society Public Education Series What Is Acute Low Back Pain? Acute low back pain (LBP) is defined as low back pain present for up to six weeks. It may be experienced