Initial Wheelchair Assessment - Virtual

Patient Information Patient name: John Doe Date of birth: 15 March 1980 Health card number: 123456789 Address: 123 Main Street, Anytown, AN 12345 Medical History Amputation details: Right leg, above-knee amputation due to trauma, 2015 Other diagnoses: Diabetes mellitus, hypertension Current mobility aids: Uses a prosthetic limb and a cane for short distances, effective for stability Physical Assessment Weight: 85 kg Hip measurement: 45 cm Back to knee measurement: 50 cm Posture: Mild scoliosis, requires lumbar support Wheelchair Assessment Type of wheelchair recommended: Power wheelchair Frame material: Aluminum Seat width: 50 cm Seat depth: 52 cm Backrest height: 60 cm Cushion type: Gel cushion for pressure relief Footrest type: Elevating footrest Bathroom Assessment Tub transfer bench: Recommended Grab bars: Recommended, placed near the toilet and shower Toilet riser: Recommended Additional Equipment Considerations Forearm crutches: Recommended for additional support Walker: Not recommended Stair lift: Recommended due to home environment with stairs Patient Goals and Concerns Main issues reported: Difficulty with long-distance mobility and fatigue Future considerations: Potential need for a more advanced power wheelchair as condition progresses Follow-up Plan Email for further communication: johndoe@example.com Trial appointment for wheelchair: Scheduled for 15 November 2024 at Anytown Rehabilitation Center