India's 1st ever
AI & Virtual Reality Based Physiotherapy Clinic
28th Cross Street, Indira Nagar, Adyar, Chennai - 600020
Patient Demographics
Name
Age
Gender
Patient-Id
Contact Number
Referring Physician
Condition
Neuro
Ortho
Diagnosis
Affected Side
CHIEF COMPLAINTS
ASSESSMENT
Knee Assessment
Shoulder Assessment
Lowback Assessment
Neck Assessment
KNEE ASSESSMENT
NPRS
Measuring Scales
Pre-score
SHOULDER ASSESSMENT
NPRS
Measuring Scales
Pre-score
LOWBACK ASSESSMENT
NPRS
Measuring Scales
Pre-score
NECK ASSESSMENT
NPRS
Measuring Scales
Pre-score
RANGE OF MOTION
JOINTS
Shoulder
Elbow
Forearm
Wrist
Neck
Hip
Knee
Ankle
Foot
Lowback
SHOULDER
Date Of Assessment
No of Movement
Pre Score (Right)
Pre Score (Left)
ELBOW
Date Of Assessment
No of Movement
Pre Score (Right)
Pre Score (Left)
FOREARM
Date Of Assessment
No of Movement
Pre Score (Right)
Pre Score (Left)
WRIST
Date Of Assessment
No of Movement
Pre Score (Right)
Pre Score (Left)
NECK
Date Of Assessment
No of Movement
Pre Score (Right)
Pre Score (Left)
HIP
Date Of Assessment
No of Movement
Pre Score (Right)
Pre Score (Left)
KNEE
Date Of Assessment
No of Movement
Pre Score (Right)
Pre Score (Left)
ANKLE
Date Of Assessment
No of Movement
Pre Score (Right)
Pre Score (Left)
FOOT
Date Of Assessment
No of Movement
Pre Score (Right)
Pre Score (Left)
LOWBACK
Date Of Assessment
No of Movement
Pre Score (Right)
Pre Score (Left)
ASSESSMENT
VOLUNTARY CONTROL
Brunstorm Grading
Pre- score
Upper Externity
Lower Externity
Neck & Trunk
MUSCLE TONE
Modified Ashworth Grading
Pre- score
Shoulder Flexors
FUNCTIONAL ASSESSMENT
Functional Independence Measure
Pre- score
Self Care
Transfer
Locomotion
GOALS
TREATMENT DURATION
TREATMENT PLAN
Day 1:
Add Day
Note * : The course and plan of treatment may change according to the patient's prognosis
TREATMENT PLAN
Week 1:
Add Week
Note * : The course and plan of treatment may change according to the patient's prognosis
COMMENTS
"Believe in your recovery, because every day is a new chance to rebuild."
Physiotherapist Name :
Date :
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