OT OASIS C FOLLOW-UP/RECERT - TriPoint Healthcare

Patient Name_____________________________________________Date:_____/_____/_____
14
Right Right ______ ______ _______
Pronation Left Left ______ ______ _______
Right Right ______ ______ _______
Wrist
Flexion Left Left ______ ______ _______
Right Right ______ ______ _______
Extension Left Left ______ ______ _______
Right Right ______ ______ _______
Ulnar Deviation Left Left ______ ______ _______
Right Right ______ ______ _______
Radical Deviation Left Left ______ ______ _______
Right Right ______ ______ _______
Thumbs
MP Flexion Left Left ______ ______ _______
Right Right ______ ______ _______
IP Extension Left Left ______ ______ _______
Right Right ______ ______ _______
Abduction Left Left ______ ______ _______
Right Right ______ ______ _______
Extension Left Left ______ ______ _______
Right Right ______ ______ ________
Opposition Left Left ______ ______ ________
Right Right ______ ______ ________
Left Fingers Right
Index Middle Ring Little Little Ring Middle Index
MP Flex
PIP Flex
DIP Flex
Abd
Tip-DPC
Functional Hand Strength
Trial #1 Trial #2 Trial #3 Trial #1 Trial #2 Trial #3
Grip
Tip Pinch
Lateral Pinch