Orthopedic Assesment

Name: ______________________________________________________________

Age: _________________________________

Sex: _________________________________

Occupation
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Address
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Floor: _____________________ Date Of Assesment: ___________________

Chief Complaints
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History
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Past Medical History

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Past Physiotherapy History

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Personal History
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Family History
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Pain History
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On Observation
Built
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Attitude Of Patient
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Trophic Changes
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Swelling
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Posture
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Wasting
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Gait
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Deformities
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On Palpation
Warmth
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Tenderness
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Spasm
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On Examination
Range Of Motion
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Muscle Power
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Muscle Girth
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Limb Length Discripancy

Umbilicus to Medial Malliolus:
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Umbilicus to ASIS:
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ASIS to Greater Trochanter:
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Greater Trochanter to Medial Condyle:
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Medial Condyle to Medial Malliolus:
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Functional Abilities
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Provisional Diagnosis
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Management
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Special Tests And Comments

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