Parent/Caregiver’s Name: PHG 1
Date of Completion: June 12, 2021
Parent/Caregiver’s Name: PHG 2
Date of Completion: June 10, 2021
Parent/Caregiver’s Name: PHG 1
Date of Completion: May 6, 2022
Report Card
| Categories | Percentile | Importance | Missing |
|---|---|---|---|
| A) Activities of Daily Living | 59.26 | hi | 0 |
| B) Gait Function and Mobility | 42.50 | hi | 2 |
| C) Pain, Discomfort and Fatigue | Insufficient Data | hi | 7 |
| D) Physical Activities, Sports and Recreation | Insufficient Data | hi | 4 |
| E) Gait Pattern and Appearance | 52.78 | hi | 0 |
| F) Use of Braces and Mobility Aids | 77.78 | hi | 0 |
| G) Body Image and Self-Esteem | 30.56 | hi | 0 |
Report Card
| Categories | Percentile | Importance | Missing |
|---|---|---|---|
| A) Activities of Daily Living | 54.32 | hi | 0 |
| B) Gait Function and Mobility | 43.00 | hi | 0 |
| C) Pain, Discomfort and Fatigue | 51.02 | hi | 0 |
| D) Physical Activities, Sports and Recreation | 45.00 | hi | 3 |
| E) Gait Pattern and Appearance | 52.78 | hi | 0 |
| F) Use of Braces and Mobility Aids | 77.78 | hi | 0 |
| G) Body Image and Self-Esteem | 30.56 | hi | 0 |
Report Card
| Categories | Percentile | Importance | Missing |
|---|---|---|---|
| A) Activities of Daily Living | 43.21 | hi | 0 |
| B) Gait Function and Mobility | 49.38 | hi | 1 |
| C) Pain, Discomfort and Fatigue | 46.43 | hi | 0 |
| D) Physical Activities, Sports and Recreation | 64.81 | hi | -1 |
| E) Gait Pattern and Appearance | 38.89 | hi | 0 |
| F) Use of Braces and Mobility Aids | 87.50 | hi | 1 |
| G) Body Image and Self-Esteem | 58.33 | hi | 0 |
A: Getting in and out of a chair (or wheelchair)
A: Washing/bathing his/her self