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Sample print-out of two page summary ( full report with graphs can be up to 38 pages)
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Your Evaluation Center
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August 1, 1999
Ms. Edna Benoiter
Big Giant Insurance Co.
100 Giant Way
New York, NY 10012
RE: Sample Patient (12345678) [Evaluated: 7-25-2009]
PURPOSE OF ASSESSMENT
Patient has completed course of physical therapy for Lumbar Sprain/Strain. Treating therapist has released patient for work. Need to determine if he can return to his own job, and what restrictions might apply.
RELIABILITY AND CONSISTENCY OF EFFORT
The results of this evaluation suggest that Mr. Patient gave a reliable effort, with 68 of 70 consistency measures within expected limits.
FUNCTIONAL ABILITIES
Patient's demonstrated abilities meet specified job demands in the following categories: Walk, Carry - 11 Lb, Carry - 21 Lb, Carry - 51 Lb, Push Cart - 41 Lb, Pull Cart - 41 Lb, Balance, Stoop, Crouch, Kneel, Climb Stairs, Reach to Front, Reach Side/Across, Reach with Weight, Handling, Bi-Manual Handling, Fingering, Bi-Manual Fingering, Feeling, Eye-Hand-Foot, Tool Use, Stand/Sit, Sitting, Standing.
FUNCTIONAL LIMITATIONS
Patient is unable to meet job demands in the following categories: Mid Lift, Low Lift, Full Lift.
CONCLUSIONS
Patient can return to work with modified duties. Limited to medium lifting category until re-evaluation is performed in six weeks.
Sincerely,
Harvey Mudd, PT
Mr. Patient’s demonstrated abilities in this evaluation (FCE) are summarized below. A value of n/a indicates the activity was not included in the evaluation. If job demands were provided with this evaluation, functional abilities are compared to the corresponding job demand level. FCE performance below job demand is shown as a Yes in the deficit column, while mixed performance (both above and below the job demand level) is shown as ? indicating a possible deficit.
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Activities Rated by Strength Level
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Activity
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FCE Performance
(PDC Category)
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Equivalent Strength Level
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Job Demand
(PDC Category)
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Deficit
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Occasional
0 to 2.6 hours/day
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Frequent
2.7 to 5.3 hours/day
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Constant
5.4 to 8 hours/day
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Low Lift (floor to knuckle)
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Medium
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21 - 50 lb
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11 - 25 lb
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1 - 10 lb
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Very Heavy
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Yes
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Mid Lift (knuckle to shoulder)
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Medium
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21 - 50 lb
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11 - 25 lb
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1 - 10 lb
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Very Heavy
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Yes
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High Lift (shoulder and above)
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n/a
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Full Lift (floor to shoulder)
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n/a
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Carry
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Very Heavy
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over 100 lb
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over 50 lb
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over 20 lb
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Heavy
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No
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Push (static)
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Heavy
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51 - 100 lb
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26 - 50 lb
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11 - 20 lb
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Medium
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No
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Pull (static)
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Medium
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21 - 50 lb
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11 - 25 lb
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1 - 10 lb
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Overall Strength Category
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n/a
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Activities Rated by Frequency and Duration
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Activity
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FCE Performance
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Job Demand
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Deficit
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Walk
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Constant
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Constant
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No
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Climb Stairs
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Constant
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Occasional
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No
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Balance
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Constant
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Frequent
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No
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Stoop
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Frequent
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Occasional
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No
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Kneel
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Constant
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Occasional
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No
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Crouch
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Frequent
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Occasional
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No
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Crawl
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Constant
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Not Required
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No
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Reach (front)
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Left: Constant
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Right: Constant
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Frequent
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No
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Reach (side)
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Left: Constant
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Right: Constant
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Frequent
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No
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Handling
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Left: Constant
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Right: Constant
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Both: Constant
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Frequent
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No
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Fingering
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Left: Constant
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Right: Constant
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Both: Constant
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Frequent
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No
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Feeling
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Constant
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Frequent
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No
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Eye-hand-foot
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Constant
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Frequent
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No
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Sitting
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Frequent
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Frequent
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No
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Standing
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Frequent
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Frequent
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No
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Push Cart
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Constant
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Frequent
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No
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Pull Cart
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Frequent
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Occasional
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No
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Other Activities
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Grip/Grasping Strength (Dynamometer Position 2)
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Left: 83.8 lb
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Right: 94.8 lb
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low
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Cardiovascular Fitness
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Above average
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