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Geriatric Assessment

The document provides a geriatric assessment sheet template used by a physiotherapy department. It includes sections to record a patient's personal details, medical history, examination findings, assessments, diagnosis, and management plan.

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Aaliyah Shaikh
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403 views3 pages

Geriatric Assessment

The document provides a geriatric assessment sheet template used by a physiotherapy department. It includes sections to record a patient's personal details, medical history, examination findings, assessments, diagnosis, and management plan.

Uploaded by

Aaliyah Shaikh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Dr. G.D.

POL FOUN DATIO N


YMT COLL EGE OF PHYSI OTHE RAPY
Institu tional Area,S ector -4,Kha rghar, Navi Mumba i-41021 0. Tel:
022-27744402

DEPARTMENT OF COMMUNITY PHYSIOTHERAPY


GERIATRIC ASSESSMENT SHEET

Patient ID: Date:

Name:
Age/ Gender: BM! :
Contact Details: Dominance:
Address:

Occupation :
Chief Complaints:

Pain History :
Site of pain-
Intensity- On rest- On Activity-
Type of pain-
Aggravating factors- Relieving factors-

History Of Present Illness-

Past History-

Systemic Review-
Musculoskeletal-
Neurological-
Cardio-vascular-
Special senses-
Bowel/bladder-

Medical History-

Surgical History-
Personal History-
Drug History-

Family History-
Environmental History-
Socio-economic status-

ASSESSMENT
On ObservatioG-
Yitals-
PR- RR- BP- BM I-
PlCCLE-

Ru ilt-
Attitude of the Limb-
Posture-

Gait-
Cse of Assistive Devices-

On Palpation:

Tenderness- Swell ing-

Spasm- Crepitus-

On Examination:

ROM-

MMT-

Tightness-

Joint Play-

Neurological Examination-

Cardio-respiratory Examination-
'\!-\~'Ill T ,\11..:Llcd l111;1c t
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\ l'h'll \ ~1111: t ____
ll_,_,...;
l'~rirlll'l•...; 11_ + - - - - - - - - - - I - - -
si,.;;o...;
1
-L,._ncpth pcrcc tion
_____ _______ _

l .,lb \~sessment-

l E~-

Functional Assessment-
\lobility-
Strength-
Flc'.'1.ibilit)-
G:iit-
Baiance-

Geriatric fitness Assessment-

Senior Fitness Test-

SPPB-

Psychological Assessment-
GDS-

Environmental Assessment-
CDC Checklist/ PEAT HSSAT

Diagnosis:

Management:

Facuh) '-..1me 8.. Sign:

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