Amputee Assessment

Form Template

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.

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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.

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