Patient Information
[Patient's full name] (include the full legal name of the patient as documented in the medical records.)
[Health card number] (include the patient’s official health card number if explicitly mentioned; otherwise, omit completely.)
[Date of birth] (record the patient’s date of birth if explicitly mentioned.)
Reason for Visit
[Explanation of why patient needs a power wheelchair] (provide a clear and concise statement on why the patient requires a power wheelchair, including any mobility limitations, pain, or difficulty using manual aids. Only include if explicitly mentioned in the transcript or clinical notes.)
Medical History
[Relevant medical conditions] (list any relevant medical conditions that impact mobility and necessitate the use of a power wheelchair. Include only if explicitly mentioned in the transcript or contextual notes.)
[Previous surgeries or replacements] (document any previous surgeries, joint replacements, or orthopedic interventions relevant to mobility. Only include if explicitly mentioned.)
Current Mobility Status
[Description of current mobility aids] (detail the mobility aids the patient currently uses, such as a walker, cane, or manual wheelchair, and their effectiveness. Only include if explicitly mentioned.)
[Difficulties with current mobility] (describe the challenges the patient faces with their current mobility, such as pain, fatigue, or inability to navigate certain environments. Only include if explicitly mentioned.)
Home Assessment
[Description of home entrance] (document how the patient accesses their home, including whether there are steps, ramps, or other barriers. Only include if explicitly mentioned.)
[Number of stairs] (record the number of stairs at the main entrance and within the home if applicable. Only include if explicitly mentioned.)
[Garage accessibility] (describe whether the patient has garage access, if it’s wheelchair-accessible, and any potential modifications needed. Only include if explicitly mentioned.)
[Proposed ramp solutions] (list any proposed ramp modifications or accessibility solutions to improve home access for the power wheelchair. Only include if explicitly mentioned.)
Power Wheelchair Assessment
[Observations of patient using power wheelchair] (document observations of the patient using a power wheelchair, including ease of use, posture, and adjustments needed. Only include if explicitly mentioned.)
[Measurements and specifications] (record necessary measurements to ensure proper wheelchair fitting. Include only if explicitly mentioned.)
[Seat width] (document the appropriate seat width based on the patient’s body size. Only include if explicitly mentioned.)
[Seat depth] (record seat depth to ensure proper support and positioning. Only include if explicitly mentioned.)
[Seat to floor height] (document the seat-to-floor height to ensure accessibility and usability. Only include if explicitly mentioned.)
[Backrest height] (record the backrest height as per the patient’s needs. Only include if explicitly mentioned.)
[Cushion type] (specify the cushion type required for comfort and pressure relief. Only include if explicitly mentioned.)
[Footrest adjustments] (document any necessary footrest adjustments to ensure comfort and proper posture. Only include if explicitly mentioned.)
Patient Physical Assessment
[Height] (record the patient’s height if explicitly mentioned in the transcript or contextual notes.)
[Weight] (record the patient’s weight if explicitly mentioned in the transcript or contextual notes.)
[Leg length] (document leg length to ensure proper wheelchair fitting and positioning. Only include if explicitly mentioned.)
[Upper body mobility] (assess the patient’s ability to control upper body movements, including hand and arm function for power wheelchair operation. Only include if explicitly mentioned.)
[Cognitive assessment] (evaluate cognitive function to determine the patient’s ability to safely operate a power wheelchair. Only include if explicitly mentioned.)
Recommendations
[Proposed power wheelchair specifications] (list the recommended wheelchair model, customizations, and any special features needed for optimal mobility and comfort. Only include if explicitly mentioned.)
[Suggested home modifications] (document any recommended modifications to the patient’s home, such as ramps, door widening, or accessible pathways. Only include if explicitly mentioned.)
Follow-up
[Next steps for application process] (outline the next steps for obtaining the power wheelchair, including documentation, approval, or funding applications. Only include if explicitly mentioned.)
[Instructions for accessible ramp planning] (provide guidance on ramp planning and installation if applicable. Only include if explicitly mentioned.)
Payment Information
[Payment method] (document how the power wheelchair will be paid for, including insurance coverage, government funding, or out-of-pocket payment. Only include if explicitly mentioned.)
[Billing details] (record billing details, including invoicing information and financial arrangements, if explicitly mentioned in the transcript or contextual notes.)
(Never come up with your own patient details, assessment, plan, interventions, evaluation, and plan for continuing care—use only the transcript, contextual notes, or clinical note as a reference for the information included in your note. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes, or clinical note, you must not state that the information has not been explicitly mentioned in your output; just leave the relevant placeholder or omit the placeholder completely.) (Use as many lines, paragraphs, or bullet points, depending on the format, as needed to capture all the relevant information from the transcript.)