Medium

Available on

Apple Android Windows

Amputee Assessment Mobile App

The Amputee Assessment mobile app provides a checklist that represents items the Centers for Medicare and Medicaid Services (CMS) have required to be documented in the medical record for all patients who are to receive a prosthetic device. Having these items documented in your patient’s medical record will help to ensure that your patient will receive the necessary prosthetic devices and to ensure that the prosthetist will be reimbursed from CMS.

You can easily document muscle strength, body weight, emotional well-being and quality of life, and the prosthetic rehabilitation process. All documentation is saved in the GoCanvas Cloud and can be printed or emailed as a PDF if you want to use it during follow-up care with the patient and any physical therapist. This app can be downloaded to an iPhone, iPad, or Android device.

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

Want to learn more about GoCanvas?

Request a Demo

Take a peek inside the Amputee Assessment 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.'}}

  • {{data.title}}

Included Fields

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

  • Ico statictext

    The following checklist represents items that the Centers for Medicare and Medicaid Services (CMS...

  • Ico statictext

    Documentation in Prescribing Physician’s Medical Records

  • Ico statictext

    Please use the following checklist to indicate that the item has been properly documented in your...

  • Ico statictext

    Physical Examination

  • Ico checkbox

    Weight & height

  • Ico checkbox

    Cardiopulmonary exam

  • Ico checkbox

    Arm/leg strength & ROM

  • Ico checkbox

    Neurologic exam

  • Ico checkbox

    Gait assessment

  • Ico checkbox

    Balance and coordination

  • Ico statictext

    Amputation History

  • Ico checkbox

    Diagnosis/cause of amputation

  • Ico checkbox

    Date of amputation(s)

  • Ico checkbox

    Amputation level

  • Ico checkbox

    Prognosis

  • Ico statictext

    Patient’s Functional Status

  • Ico checkbox

    Description of ADLs and their impact by deficit

  • Ico checkbox

    Diagnoses causing ADL deficits

  • Ico checkbox

    Other comorbidities related to ambulation deficits or that could impact use of new prosthetic device

  • Ico checkbox

    Current ambulatory assistive devices used by patient

  • Ico checkbox

    Patient’s functional status prior to amputation

  • Ico checkbox

    Patient’s current functional capabilities

  • Ico checkbox

    K-level assigned to patient’s current functional capabilities

  • Ico checkbox

    Patient’s expected functional potential

  • Ico checkbox

    K-level assigned to patient’s expected functional capabilities

  • Ico checkbox

    Explanation for difference between current and expected functional capabilities

  • Ico checkbox

    Current status of residual limb

  • Ico checkbox

    Status of current prosthesis/component(s)

  • ...and More!

Related Health Care & Social Services Apps... and they're all free for GoCanvas subscribers!

App Name

Sample Letter For Gender Reassignment...

Gender reassignment surgery is becoming a common procedure. Surgery for transitioning from male to female or female to mal...

App Name

Ambulatory Patient:: Clinic Assessmen...

The Ambulatory Patient: Clinic Assessment of Safety Culture mobile app recommends an evaluation of a culture of safety ref...

App Name

Ambulatory Patient:: My Medicine List

Use the Ambulatory Patient: My Medicine List mobile app to assess accuracy of medication list as well as allergy list. Alw...

App Name

Chart Audit Form

The Chart Audit Form mobile app audits medical charts for compliance. The app provides detailed checklists for the followi...

App Name

General Peer Review Chart Audit

The General Peer Review Chart Audit mobile app makes it easy to complete a peer review of medical charts using a smartphon...

App Name

Medical Record Audit Tool

Use the Medical Record Audit Tool mobile app to administer clinical audits. The app checks: chart, informed consent, admit...

App Name

Ambulatory Patient:: Ambulatory Site ...

The Ambulatory Patient: Ambulatory Site Clinic Survey mobile app audits the following: External Access/Appearance, Interna...

App Name

Ambulatory Patient:: Checklist on Saf...

Advanced age should not automatically be equated with dangerous driving, because many older drivers are quite capable driv...

More Information