Guideline to Fill the Statistical Forms

GUIDELINE TO FILL THE STATISTICAL FORMS

AND TREATMENT SHEETS

FOR THE PHYSIOTHERAPY SERVICES

Ø  STATISTICAL FORM

See Statistical Form in file “Physio Stat Form Proposal / Statformcopy” to make photocopies and in file “Physio Stat Form Proposal / Statformcounting” for automatic counting’s.

NOTE : The three first boxes of the statistical forms are to register only the new cases during the considered month.

The fourth and last box of the statistical form registers all the patients during the considered month, it means the new cases and the cases from the precedent months that are still going on their treatments.

GROUPS OF PATHOLOGIES

PARA/QUADRIPLEGIA : Para/Quadriplegia, Spina Bífida, Multiple sclerosis, Lateral Amiotrofic sclerosis, Seringomielia, Parkinson disease and Tabes.

HEMIPLEGIA / COMA: Hemiplegias (Vascular Cerebral Accident
and Traumatism Encéfalo Cranial), Coma.

PERIPHERIC PARALYSIS : Injuries of the plexus and nerves, Polineuritis, Polirradiculoneuritis, Obstetric paralysis, Erb’s Paralysis, Brachial plexus lesions, Poliomyelitis.

CEREBRAL PALSY : Cerebral palsy, Encephalopaties, Aftereffects of Meningitis.

ORTHOPAEDIC SURGERY: Total prosthesis of the hip or knee, Osteotomy, Harrington.

ORTHOPAEDIC DEFORMITIES : Scoliosis, Kyphosis, Lordosis, Club feet, Osteodistrophy, Spondilosis, Congenital luxation, Valgum, Varum, Flexum and Recurvatum.

MUSCULAR DISTROPHIES : All kinds of muscular distrophies.

GENERAL SURGERY : General surgery, patients in bed.

TRAUMATOLOGY: Fractures, Entorses, Traumatic luxations.

AMPUTATION : Amputations.

BURNS : All kind of burns.

RHEUMATOLOGY : Arthritis, Rheumatoid Arthritis, Arthrosis, Tendinitis, Bursitis, Bones Pathologies (Osteoporosis and Osteonecrosis), Cervicalgies, Dorsalgies, Lombalgies and Sciaticas.

CARDIOVASCULAR / LYMPHATIC: Myocardial infarction, Cardiopathies, Phlebitis, Oedema.

PNEUMOLOGY : Bronchitis, Asthma, Mucoviscidosis,
Enphisema, Atelectasis, Pneumonia, Pulmonar Tuberculosis, Thoracic Surgery, Pleurisy, Pneumohaemothorax, Respiratory Paralysis.

PAEDIATRICS :

GYNAECOLOGY : Post-partum paralysis, Post-partum rehabilitation, Bladder rehabilitation.

GERONTOLOGY : Eschar, Gait training, good positioning in bed, Gymnastic.

ONCOLOGY : All cancers needing rehabilitation.

“PATHOLOGY / AGE” AND “CAUSE / AGE” BOXES

The totals of each columns of the “Pathology / Age” box are equals to the totals of the same columns of the “Cause / Age” box.

For example, if the total of the column “16 – 50” of the “Pathology / Age” box is 33, the total of the column “16 – 50” of the “Cause / Age” box must be of 33.

“PATHOLOGY / AGE”, “ETIOLOGY / AGE” AND “GENDER” BOXES

The total of all new cases from the “Pathology / Age” box, the total of all new cases from the “Cause / Age” box and the total of all new cases from the “Gender” box must be equals.

LAST BOX

The total number of patients must be equal to the sum of the total number of in-patients and of the total number of the out-patients. Total number of patients means the new cases and the cases still having treatment starting from the preceding months.

The number of treatments received is registered every time the patient received a kinesio and / or electro and / or thermo and / or hydro treatment. The registration of the treatments is done with treatment sheet used buy every physiotherapist and physiotherapy technician.

Ø  TREATMENT SHEET

NOTE: The treatment sheet is not an assessment sheet. This sheet is only to help the physiotherapists and the physiotherapy technicians to fill the statistical form.

·  Column «N°”

Number of the patient on the sheet.

·  New Patients

Write a dot (·) in front of the numbers of the new patients.

·  Column “Name”

Names of the patients.

·  Column “Pathology”

Write the pathology of the corresponding patient according to the pathologies of the statistical form.

·  Column “Cause”

Write the Cause of the corresponding patient according to the Causes of the statistical form.

·  Column “A”

“A” is corresponding to Age. Write the age of the patient.

·  Column “G”

“G” is corresponding to Gender. Write the gender of the patient (M or F).

·  Columns “K, E, T, H”

“T” is corresponding to Treatment. Write a cross to the treatments received by the patient:

K = Kinesiotherapy treatment

E = Electrotherapy treatment

T = Thermotherapy treatment

H = Hydrotherapy treatment

·  Column “P”

“P” is corresponding to Patient. Write “I” for In-patients; write “O” for Out-patients.

·  Columns with numbers from 1 to 31.

These are the days of the month. Write a cross on the days when a patient receives treatment.

At the end of the month, you just have to count and fill the monthly statistical form. Every physiotherapist and physiotherapy technician must fill it’s own monthly statistical form. The physiotherapy responsible will compile the forms to fill one for all the physiotherapy service’s activity to be sent to the Ministry of Health / Physical Medicine and Rehabilitation Unit.

One copy of the physiotherapy service’s monthly statistical form must be filed in the physiotherapy service office and one copy must e submitted to the hospital direction / administration.

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