style="background-color:CCCCFF" > checked /> 1 independent
checked /> 2 requires assistance
checked /> 3 dependent

style="background-color:CCCCFF" > checked /> 1 independent
checked/> 2 requires assistance
checked/> 3 dependent

style="background-color:CCCCFF" > checked /> 1 independent
checked /> 2 requires assistance
checked /> 3 dependent

style="background-color:CCCCFF" > checked /> 1 independent
checked /> 2 requires assistance
checked /> 3 dependent

style="background-color:CCCCFF" > checked /> 1 independent
checked /> 2 requires assistance
checked /> 3 dependent

style="background-color:CCCCFF" > checked /> 1 independent
checked /> 2 requires assistance
checked /> 3 dependent

style="background-color:CCCCFF" > checked /> 1 independent
checked /> 2 requires assistance
checked /> 3 dependent

style="background-color:CCCCFF" > checked /> 1 independent
checked /> 2 requires assistance
checked /> 3 dependent

style="background-color:CCCCFF" > checked/> 1 independent
checked/> 2 requires assistance
checked/> 3 dependent

style="background-color:CCCCFF" > checked /> 1 independent
checked /> 2 requires assistance
checked /> 3 dependent

style="background-color:CCCCFF" > checked /> 1 independent
checked /> 2 requires assistance
checked /> 3 dependent

style="background-color:CCCCFF" > checked /> 1 independent
checked/> 2 requires assistance
checked/> 3 dependent

style="background-color:CCCCFF" > checked /> 1 independent
checked /> 2 requires assistance
checked /> 3 dependent

style="background-color:CCCCFF" > checked /> 1 independent
checked/> 2 requires assistance
checked/> 3 dependent

style="background-color:CCCCFF" > checked/> 1 independent
checked/> 2 requires assistance
checked/> 3 dependent

style="background-color:CCCCFF" > checked /> 1 independent
checked /> 2 requires assistance
checked /> 3 dependent

style="background-color:CCCCFF" > checked> 1 No Movement
checked> 2 Palpable contraction no visible movement
checked> 3 Movement but only with good gravity eliminated
checked> 4 Movement against gravity
checked> 5 Movement against resistance but weaker than normal
checked> 6 Normal Power

style="background-color:CCCCFF" > checked > 1 No Movement
checked > 2 Palpable contraction no visible movement
checked > 3 Movement but only with good gravity eliminated
checked > 4 Movement against gravity
checked > 5 Movement against resistance but weaker than normal
checked > 6 Normal Power

style="background-color:CCCCFF" > checked> 1 No Movement
checked> 2 Palpable contraction no visible movement
checked> 3 Movement but only with good gravity eliminated
checked> 4 Movement against gravity
checked> 5 Movement against resistance but weaker than normal
checked> 6 Normal Power

style="background-color:CCCCFF" > checked> 1 No Movement
checked> 2 Palpable contraction no visible movement
checked> 3 Movement but only with good gravity eliminated
checked> 4 Movement against gravity
checked> 5 Movement against resistance but weaker than normal
checked> 6 Normal Power

style="background-color:CCCCFF" > checked> 1 No Movement
checked> 2 Palpable contraction no visible movement
checked> 3 Movement but only with good gravity eliminated
checked> 4 Movement against gravity
checked> 5 Movement against resistance but weaker than normal
checked> 6 Normal Power

style="background-color:CCCCFF" > checked> 1 No Movement
checked> 2 Palpable contraction no visible movement
checked> 3 Movement but only with good gravity eliminated
checked> 4 Movement against gravity
checked> 5 Movement against resistance but weaker than normal
checked> 6 Normal Power

style="background-color:CCCCFF" > Checked> 1 No Movement
Checked> 2 Palpable contraction no visible movement
Checked> 3 Movement but only with good gravity eliminated
Checked> 4 Movement against gravity
Checked> 5 Movement against resistance but weaker than normal
Checked> 6 Normal Power

style="background-color:CCCCFF" > Checked> 1 No Movement
Checked> 2 Palpable contraction no visible movement
Checked> 3 Movement but only with good gravity eliminated
Checked> 4 Movement against gravity
Checked> 5 Movement against resistance but weaker than normal
Checked> 6 Normal Power

style="background-color:CCCCFF" > checked> 1 No Movement
checked> 2 Palpable contraction no visible movement
checked> 3 Movement but only with good gravity eliminated
checked> 4 Movement against gravity
checked> 5 Movement against resistance but weaker than normal
checked> 6 Normal Power

style="background-color:CCCCFF" > Checked> 1 No Movement
Checked> 2 Palpable contraction no visible movement
Checked> 3 Movement but only with good gravity eliminated
Checked> 4 Movement against gravity
Checked> 5 Movement against resistance but weaker than normal
Checked> 6 Normal Power

style="background-color:CCCCFF" > checked> 1 No Movement
checked> 2 Palpable contraction no visible movement
checked> 3 Movement but only with good gravity eliminated
checked> 4 Movement against gravity
checked> 5 Movement against resistance but weaker than normal
checked> 6 Normal Power

style="background-color:CCCCFF" > checked> 1 No Movement
checked> 2 Palpable contraction no visible movement
checked> 3 Movement but only with good gravity eliminated
checked> 4 Movement against gravity
checked> 5 Movement against resistance but weaker than normal
checked> 6 Normal Power

style="background-color:CCCCFF" > checked> 1 No Movement
checked> 2 Palpable contraction no visible movement
checked> 3 Movement but only with good gravity eliminated
checked> 4 Movement against gravity
checked> 5 Movement against resistance but weaker than normal
checked> 6 Normal Power

style="background-color:CCCCFF" > Checked> 1 No Movement
Checked> 2 Palpable contraction no visible movement
Checked> 3 Movement but only with good gravity eliminated
Checked> 4 Movement against gravity
Checked> 5 Movement against resistance but weaker than normal
Checked> 6 Normal Power

style="background-color:CCCCFF" > checked> 1 No Movement
checked> 2 Palpable contraction no visible movement
checked> 3 Movement but only with good gravity eliminated
checked> 4 Movement against gravity
checked> 5 Movement against resistance but weaker than normal
checked> 6 Normal Power

style="background-color:CCCCFF" > checked> 1 No Movement
checked> 2 Palpable contraction no visible movement
checked> 3 Movement but only with good gravity eliminated
checked> 4 Movement against gravity
checked> 5 Movement against resistance but weaker than normal
checked> 6 Normal Power

style="background-color:ccccff">

Flexion - PROM - Right Flexion - PROM - Left Flexion - AROM - Right Flexion - AROM - Left Hyperextension - PROM - Right Hyperextension - PROM - Left Hyperextension - AROM - Right Hyperextension - AROM - Left

<cfoutput>#oteform.UTI_M0510#</cfoutput>

70 75 60 50 example 10 30 50 65

style="background-color:ccccff">

Pronation - PROM - Right Pronation - PROM - Left Pronation - AROM - Right Pronation - AROM - Left Supination - PROM - Right Supination - PROM - Left Supination - AROM - Right Supination - AROM - Left

<cfoutput>#oteform.Urinary_INcont_when_M0530#</cfoutput>

style="background-color:ccccff">

Extension - PROM - Right Extension - PROM - Left Extension - AROM - Right Extension - AROM - Left Flexion - PROM - Right Flexion - PROM - Left Flexion - AROM - Right Flexion - AROM - Left Radial Deviation - PROM - Right Radial Deviation - PROM - Left Radial Deviation - AROM - Right Radial Deviation - AROM - Left Ulnar Deviation - ROM - Right Ulnar Deviation - PROM - Left Ulnar Deviation - AROM - Right Ulnar Deviation - AROM - Left

<cfoutput>#oteform.Ostomy_for_Bowel_M0550#</cfoutput>

style="background-color:ccccff">

Flexion - PROM - Right Flexion - PROM - Left Flexion - AROM - Right Flexion - AROM - Left Extension - PROM - Right Extension - PROM - Left Extension - AROM - Right Extension - AROM - Left

<cfoutput>#oteform.When_Confused_M0570#</cfoutput>

style="background-color:CCCCFF" > checked /> 1 Absent checked /> 2 Impaired checked /> 3 Intact

style="background-color:CCCCFF" > checked /> 1 Absent checked /> 2 Impaired checked /> 3 Intact

style="background-color:CCCCFF" > checked /> 1 Absent checked /> 2 Impaired checked /> 3 Intact

style="background-color:CCCCFF" > checked /> 1 Absent checked /> 2 Impaired checked /> 3 Intact

style="background-color:CCCCFF" > checked /> 1 Absent checked /> 2 Impaired checked /> 3 Intact

style="background-color:CCCCFF" > checked /> 1 Absent checked /> 2 Impaired checked /> 3 Intact

style="background-color:CCCCFF" > checked /> 1 Absent checked /> 2 Impaired checked /> 3 Intact

style="background-color:CCCCFF" > checked /> 1 Absent checked /> 2 Impaired checked /> 3 Intact

style="background-color:CCCCFF" > checked/> 1 Absent checked /> 2 Impaired checked /> 3 Intact

style="background-color:CCCCFF" > checked /> 1 Absent checked /> 2 Impaired checked /> 3 Intact

style="background-color:CCCCFF">

checked> pain level 0 (low)	checked > pain level 6 (med)
checked > pain level 1 (low)	checked > pain level 7 (high)
checked > pain level 2 (low)	checked > pain level 8 (high)
checked > pain level 3 (med)	checked > pain level 9 (high)
checked> pain level 4 (med)	checked > pain level 10 (high)
checked > pain level 5 (med)	checked >Other...
<cfoutput>#oteform.Ambulation_M0700#</cfoutput>

style="background-color:CCCCFF">

checked onclick="showTextAreapain();"/> Throbbing	checked /> Aching	checked /> Shooting
checked /> Stabbing	checked /> Burning	checked /> Not Applicable
checked /> Sharp	checked/> Numb	checked /> Other...
<cfoutput>#oteform.Ambulation_M0700p#</cfoutput>

style="background-color:CCCCFF" >

checked /> at rest	checked /> Not Applicable
checked /> with minimal activity
checked /> with moderate activity
checked /> with strenuous activity

style="background-color:CCCCFF" >

checked /> 1 checked /> 2 checked /> 3 checked /> 4 checked /> 5

checked /> 6 checked /> 7 checked /> 8 checked /> 9 checked /> 10

style="background-color:CCCCFF" >

checked /> 30 minute checked /> 1 hour checked /> 2 hours checked /> 3 hours checked /> 4 hours

checked /> 6 hours checked /> 12 hours checked /> 24 hours checked /> more than 24 hours checked /> Not Applicable

style="background-color:CCCCFF" > checked > physical activity
checked /> disease process
checked /> Not Applicable

style="background-color:CCCCFF" > checked /> 0 - Never, patient is not short of breath
checked /> 1 - When walking more than 20 feet, climbing
checked /> 2 - With moderate exertion
checked /> 3 - With minimal exertion or with agitation
checked /> 4 - At rest (during day or night)

style="background-color:CCCCFF" > checked /> Enlarged
checked /> Warm
checked /> Red
checked /> Stiff
checked /> Painful
checked /> Asymptomatic

style="background-color:CCCCFF" >

checked /> 4 wheeled walker checked /> bath bench checked /> cane checked /> commode checked /> grab bars checked /> hospital bed checked /> hoyer lift checked /> large base quad cane checked /> long leg brace checked /> reacher checked /> rolling walker checked /> small base cane checked /> walker checked /> wheelchair checked /> Other...

#oteform.Laundry_M0740#

style="background-color:ccccff"> <cfoutput>#oteform.Laundry_M0740p#</cfoutput>

style="background-color:CCCCFF" >

checked /> Dizziness checked /> Impaired cognition/communication/behavior checked /> Decreased muscle tone checked /> Decreased sensation checked /> Impaired coordination checked /> Impaired posture checked /> Decreased range of motion checked /> Decreased strength checked /> Decreased endurance checked /> Asymptomatic checked /> Other...

#oteform.Laundry_M0740#

style="background-color:CCCCFF" > checked /> 0 - Guarded: minimal improvement in functional status is expected; decline is possible
checked /> 1 - Good: marked improvement in functional status is expected
checked /> UK - Unknow