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Lembar Bagan ICF

This document is a form for recording a patient's information, health condition, body functions and structures, activities, participation, as well as environmental and personal factors. It collects a patient's name, age, gender, phone number, address and current health condition. The form also charts impairments, limitations, and restrictions across body functions/structures, activities, and participation with consideration of environmental and personal factors.

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alvianwp
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622 views1 page

Lembar Bagan ICF

This document is a form for recording a patient's information, health condition, body functions and structures, activities, participation, as well as environmental and personal factors. It collects a patient's name, age, gender, phone number, address and current health condition. The form also charts impairments, limitations, and restrictions across body functions/structures, activities, and participation with consideration of environmental and personal factors.

Uploaded by

alvianwp
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Lembar Bagan ICF

Nama Pasien: Umur: Jenis Kelamin : No. Hp:


Alamat:
Health Condition

Body Function and Structure Activities Participation


(Impairment) (Limitation) (Restriction)

Environmental Factors Personal Factors

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