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Goniometer Assessment Report Template

This document is a format to measure the range of motion of the main joints of the human body using a goniometer. It provides spaces to measure the range of motion for joints such as the temporomandibular, neck, back, shoulders, elbows, wrists, fingers, hips, and more, for both sides of the body.

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20 views6 pages

Goniometer Assessment Report Template

This document is a format to measure the range of motion of the main joints of the human body using a goniometer. It provides spaces to measure the range of motion for joints such as the temporomandibular, neck, back, shoulders, elbows, wrists, fingers, hips, and more, for both sides of the body.

Translated by

ScribdTranslations
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Nombre: Goniometer

Fecha de Nacimiento: TYPE


Sexo:
Articulation
Temporomandib
LEFT ular RIGHT
Range of Range of
Arm Arm Arm Arm
Axis Movement Axis Movement
Fixed Mobile Fixed Mobile
o o

Promotion
Descent
Protrusion
Retraction
Laterality
Firm Firm
a Company Company Company EXAMINER a CompanyCompany Company

Comentarios:

Nombre: GONIOMETER
Fecha de Nacimiento: TYPE
Sexo:
LEFT NECK RIGHT
Arm Arm Range of Arm Arm Range of
Axis Axis
Fixed Mobile Movement Fixed Mobile Movement

Flexion
Extension
Inclination
Rotation
Company Company Company Company EXAMINER Signature Signature Company Company

Comentarios:

Nombre: Goniometer
Fecha de Nacimiento: TYPE
Sexo:
RAQUIS
LEFT DORSOLUMB RIGHT
AR
Arm Arm Range of Arm Arm Range of
Axis Axis
Fixed Mobile Movement Fixed Mobile Movement

Flexion
Extension
Inclination
Rotation
EXAMINED
Company Company Company Company R Company Company Company Company

Comentarios:
Nombre: GONIOMETER
Date of Birth: TYPE
Sexo:
LEFT SHOULDER RIGHT
Arm Arm Range of Arm Arm Range of
Axis Axis
Fixed Mobile Movement Fixed Mobile Movement

Flexion
Extension
Abduction
Adduction
Rotation
External
Rotation
Internal
Firma Firma Company Company EXAMINER Signature Signature Company Company

Comentarios:

Nombre: Goniometer
Fecha de Nacimiento: TYPE
Sexo:
LEFT CODO RIGHT
Arm Arm Range of Arm Arm Range of
Axis Axis
Fixed Mobile Movement Fixed Mobile Movement

Flexion
Extension
Pronation
Supination
Company Company Company Company EXAMINER Signature Signature Company Company

Comentarios:

Name: Goniometer
Fecha de Nacimiento: TYPE
Sex:
LEFT DOLL RIGHT
Arm Arm Range of Arm Arm Range of
Axis Axis
Fixed Mobile Movement Fixed Mobile Movement

Flexion
Extension
Abduction
Adduction
Company Company Company Company EXAMINER Signature Signature Company Company

Comentarios:
Name: Goniometer
Date of Birth: TYPE
Sex:
METACARPUS
LEFT FALANGICA RIGHT
FINGERS
Range of Range of
Arm Arm Arm Arm
Axis Movement Axis Movement
Fixed Mobile Fixed Mobile
o o

Bending
Extension
Abduction
Adduction
Firm Firm
a Company Company Company EXAMINER a Company Company Company

Comentarios:

Nombre: Goniometer
Fecha de Nacimiento: TYPE
Sexo:
METACARPAL
FALANGICA
LEFT THUMB RIGHT
Range of
Arm Arm Arm Arm
Axis Movement Axis Range of
Fixed Mobile Fixed Mobile
o Movement

Flexion
Extension
Firm Company
a Company Company Company EXAMINER Companya Company Company

Comentarios:

Nombre: goniometer
Fecha de Nacimiento: TYPE
Sex:
CARPOMETACARPAL
LEFT ANA PULGAR RIGHT
Range of Range of
Arm Arm Arm Arm
Axis Movement Axis Movement
Fixed Mobile Fixed Mobile
o o

Flexion
Extension
Abduction
Adduction
Opposition
Firm Firm
a Company Company Company EXAMINER a Company Company Company

Comentarios:

Name: Goniometer
Fecha de Nacimiento: TYPE
Sexo:
ARTICULATION
LEFT INTERFALANGICA RIGHT
Range of
Arm Arm Arm Arm
Axis Movement Axis Range of
Fixed Mobile Fixed Mobile
o Movement

Flexion
Extension
Firm Firm
a Company Company Company EXAMINER Firma a Company Company

Comentarios:

Name: Goniometer
Fecha de Nacimiento: TYPE
Sexo:
LEFT HIP RIGHT
Arm Arm Range of Arm Arm Range of
Axis Axis
Fixed Mobile Movement Fixed Mobile Movement

Flexion
Extension
Abduction
Adduction
Rotation
External
Rotation
Internal
Company Company Company Company EXAMINER Signature Signature Company Company

Comentarios:

Nombre: Goniometer
Fecha de Nacimiento: TYPE
Sexo:
LEFT Knee RIGHT
Axis Arm Arm Range of Axis Arm Arm Range of
Fixed Mobile Movement Fixed Mobile Movement
Flexion
Extension
EXAMINED
Company Company Company Company R Company Company Company Company

Comentarios:

Name: Goniometer
Fecha de Nacimiento: TYPE
Sexo:
LEFT ANKLE RIGHT
Arm Arm Range of Arm Arm Range of
Axis Axis
Fixed Mobile Movement Fixed Mobile Movement

Dorsiflexion
Plant flexion
EXAMINED
Company Company Company Company R Company Company Company Company

Comentarios:

Nombre: Goniometer
Fecha de Nacimiento: TYPE
Sexo:
SUBASTRAGAL
LEFT INA RIGHT
Arm Arm Rango de Arm Arm Range of
Axis Axis
Fixed Mobile Movement Fixed Mobile Movement

Investment
Eversion
Company Company Company Company EXAMINER Signature Signature Company Company

Comentarios:

Name: Goniometer
Fecha de Nacimiento: TYPE
Sexo:
METATARSAL
LEFT RIGHT
FALANGICA
Axis Arm Arm Range of Axis Arm Arm Range of
Fixed Mobile Movement Fixed Mobile Movement
Flexion
Extension
Company Company Company Company EXAMINER Signature Signature Company Company

Comentarios:

Nombre: Goniometer
Date of Birth: TYPE
Sex:
ARTICULATION
N
INTERFALANG
LEFT ICA RIGHT
Arm Arm Range of Arm Arm Range of
Axis Axis
Fixed Mobile Movement Fixed Mobile Movement

Flexion
Extension
Company Company Company Company EXAMINER Signature Signature Company Company

Comentarios:

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