Mobility evaluation form 2025

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The document is a comprehensive Seating and Mobility Evaluation form used to assess a patient's needs for mobility aids and seating systems. It includes sections for patient information, medical history, home environment, functional limitations, communication abilities, sensation and skin issues, current mobility equipment, and recommendations for new mobility bases and seating components. The evaluation aims to identify the patient's goals, caregiver concerns, and specific requirements to ensure safe and effective mobility solutions.

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Click ‘Get Form’ to open the mobility evaluation form in the editor.
Begin by filling out the 'Patient Information' section. Enter the patient's name, date of birth, address, and contact details for the physician and therapists involved.
Proceed to the 'Medical History' section. Input relevant ICD9 codes and any recent changes in health status, including weight trends and diagnoses.
In the 'Home Environment' section, specify living arrangements and accessibility features such as ramps or stairs that may affect mobility.
Complete the 'Community ADL' section by detailing transportation needs and any specific requirements related to mobility devices.
Fill out the 'Functional/Sensory Processing Skills' section, noting any concerns that may impact safe wheelchair operation.
Finally, review all sections for accuracy before saving or sharing your completed form using our platform's export options.

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What is a mobility evaluation for a power wheelchair?

An accurate assessment ensures the right equipment will be used, which protects workers and patients from injury. Who completes a Patient Mobility Assessment? completed by a licensed clinician; such as a nurse or physical therapist.

What happens at a mobility assessment?

A mobility assessment covers all areas of movement, from turning over in bed to sitting, standing and walking. A physiotherapist will assess your ability to carry out these tasks by studying your gait, balance and overall strength.

Who performs a mobility assessment?

In addition to reviewing orders regarding weight-bearing and assistance required, all staff should assess patient mobility before and during interventions, such as transferring from surface to surface or during ambulation.

What is a mobility evaluation?

A mobility assessment typically includes five main elements: balance, gait, transfer skills, range of motion, and overall functional ability. The combination of all these elements helps evaluate a persons ability to move and change position.

What are the basic assessment and evaluation for mobility?

In most cases the physical assessment will also include a full musculoskeletal examination of the users range of motion, joint flexibility, muscle length, and skeletal alignment, with neurological issues such as tone and spasm pattern also noted as they affect posture and muscle length.