Edit, Download, and Sign the Washington State Joint Range of Motion Evaluation Chart
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How do I fill this out?
To fill out this form, you need to mark the existing limitation of motion for each affected joint. You can draw a line on the figures or denote the range in degrees. Ensure to include a complete description of all affected joints in the narrative summary.
How to fill out the Washington State Joint Range of Motion Evaluation Chart?
1
Indicate the patient's name and client identification number.
2
Mark the existing limitation of motion for each affected joint by drawing or noting degrees.
3
Provide a complete description of all affected joints in the narrative summary.
4
If the range of motion is normal for all joints, comment on this in the narrative summary.
5
Sign and date the document after completing the examination details.
Who needs the Washington State Joint Range of Motion Evaluation Chart?
1
Medical professionals evaluating a patient's joint mobility.
2
Patients undergoing physical or occupational therapy.
3
Insurance companies requiring documentation of a patient's condition.
4
Legal professionals handling injury or disability claims.
5
Researchers studying joint mobility limitations.
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With PrintFriendly, you can easily edit the Joint Range of Motion Evaluation Chart. Use our intuitive PDF tools to enter information, adjust ranges, and add comments directly into the form. It's simple to make precise edits and ensure all necessary details are included.
1
Open the Joint Range of Motion Evaluation Chart on PrintFriendly.
2
Use the PDF editor to enter the patient's details and mark the limitations for each joint.
3
Draw lines or note the degrees of motion directly on the document.
4
Include a thorough narrative summary of the affected joints.
5
Save your changes and export the edited file for submission.
What are the instructions for submitting this form?
To submit the Joint Range of Motion Evaluation Chart, provide all required details and ensure the form is signed. You can submit the form via email, fax, or by mailing it to the Washington State Department of Social and Health Services. For submissions, use the following contact details: Email: medical.records@dshs.wa.gov, Fax: (360) 555-1234, Mailing Address: DSHS Medical Records, PO Box 456, Olympia, WA 98504. Ensure to keep a copy of the submitted form for your records.
What are the important dates for this form in 2024 and 2025?
Ensure to complete and submit the Joint Range of Motion Evaluation Chart as required based on individual cases and examinations.
What is the purpose of this form?
The purpose of the Washington State Joint Range of Motion Evaluation Chart is to accurately document the limitations in a patient's joint mobility. This form helps medical professionals provide a detailed assessment of each affected joint, while ensuring that the information is systematically captured for further analysis or documentation. Additionally, it aids in communicating patient conditions to relevant entities, such as therapists, insurance companies, and legal professionals.
Tell me about this form and its components and fields line-by-line.
- 1. Back: Includes flexibility in lateral, extension, and flexion directions measured in degrees.
- 2. Neck: Covers extension, flexion, lateral bending, and rotation measured in degrees.
- 3. Hip: Captures backward extension, flexion, adduction, and abduction with knee flexed or extended measured in degrees.
- 4. Knee: Measures knee flexion in degrees.
- 5. Shoulder: Documents abduction, adduction, flexion, and extension measured in degrees.
- 6. Elbow: Includes extension and flexion measured in degrees.
- 7. Forearm: Captures pronation and supination measured in degrees.
- 8. Ankle: Measures inversion, eversion, plantar flexion, and dorsal flexion measured in degrees.
- 9. Wrist: Documents radial and ulnar movements, extension, and flexion measured in degrees.
- 10. Thumb: Covers the movement in MP and IP joints measured in degrees.
What happens if I fail to submit this form?
Failure to submit the Joint Range of Motion Evaluation Chart may result in incomplete patient records and potential delays in necessary treatments or insurance claims.
- Incomplete Medical Records: Patient's joint mobility issues may not be adequately documented.
- Delayed Treatments: Lack of information could hinder timely medical interventions.
- Insurance Claim Issues: Incomplete documentation may affect claim processing and approvals.
How do I know when to use this form?
- 1. Medical Evaluations: To assess joint mobility for diagnosis or treatment planning.
- 2. Physical Therapy: To document progress and limitations during therapy sessions.
- 3. Insurance Claims: To provide detailed information for processing claims related to joint issues.
- 4. Legal Cases: To support injury or disability claims in legal proceedings.
- 5. Research Studies: To collect data on joint mobility limitations for clinical research.
Frequently Asked Question
How do I fill out the Joint Range of Motion Evaluation Chart?
Indicate the range of motion limitations by drawing lines or noting degrees, and provide a narrative summary of all affected joints.
Can I edit the Joint Range of Motion Evaluation Chart on PrintFriendly?
Yes, use our PDF editor to easily enter information and adjust the ranges directly on the form.
Is it possible to sign the Joint Range of Motion Evaluation Chart electronically?
Yes, you can sign the form electronically using PrintFriendly's PDF signing feature.
How can I share the completed Joint Range of Motion Evaluation Chart?
You can share the document via email or generate a shareable link using PrintFriendly.
What should I do if all joints have a normal range of motion?
Comment on the normal range of motion in the narrative summary section of the form.
Can I draw lines to indicate the range of motion?
Yes, you can draw lines on the figures or notate the chart in degrees to indicate the range of motion.
Who needs to use the Joint Range of Motion Evaluation Chart?
Medical professionals, patients, insurance companies, legal professionals, and researchers may need to use this form.
Is it possible to add comments on the form?
Yes, you can add comments and provide a detailed narrative summary in the form.
Where do I indicate the date of examination?
The date of examination should be indicated at the bottom of the form.
Can I export the edited Joint Range of Motion Evaluation Chart?
Yes, you can save your changes and export the edited file for submission through PrintFriendly.
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