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Physical Medicine and Rehabilitation Questionnaire Mobile App

The Physical Medicine and Rehabilitation Questionnaire mobile app allows patients to report pain and medical concerns using a mobile device This app can be completed in minutes. A GoCanvas account can be specified as being HIPAA compliant. By turning on HIPAA compliance, a number of features that most of users find desirable will be disabled to meet HIPAA Standards. Individual apps in the GoCanvas Application Store can easily be made HIPAA Compliant. If you have any questions or need assistance you can contact our Sales team to help you at Sales@GoCanvas.com. If you would like to enable HIPAA on your GoCanvas account please follow the instructions below: 1. Log onto your Account 2. Click “My Account” in the top right corner of the screen 3. Click “Customize” on the left 4. The third option is for HIPAA Compliance, click “Edit” on the right 5. Check the “Enable HIPAA Compliance” box and select “Save”

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Physical Medicine and Rehabilitation Questionnaire Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Name:

  • Ico date

    Date:

  • Ico textbox

    Referring Physician:

  • Ico multiline

    )Where you feel pain.

  • Ico multiline

    ) Does your pain moves?

  • Ico multiline

    ) If you feel numbness or tingling?

  • Ico statictext

    4) Using the scale, please indicate how bad your pain is:

  • Ico dropdown

    a.

  • Ico dropdown

    b.

  • Ico dropdown

    c.

  • Ico date

    If your pain is due to an injury, what was the date of injury?

  • Ico multiline

    ) What started your pain or what were you doing when your pain started?

  • Ico checkbox

    ) Do you feel you have weakness?

  • Ico checkbox

    ) Do you have back/neck muscle spasms?

  • Ico checkbox

    ) Do you have arm/leg cramps?

  • Ico checkbox

    ) Do you have headaches along with the other pain?

  • Ico dropdown

    ) How many years have you been having pain?

  • Ico dropdown

    ) When did your most recent episode of pain start?

  • Ico dropdown

    ) Which best describes the duration of your pain?

  • Ico dropdown

    ) During which part of the day is your pain the worst?

  • Ico statictext

    Please check ALL that apply:

  • Ico statictext

    ) How would you describe your pain?

  • Ico checkbox

    a.

  • Ico checkbox

    b.

  • Ico checkbox

    c.

  • Ico checkbox

    d.

  • Ico checkbox

    e.

  • Ico checkbox

    f.

  • ...and More!

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