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You are here: Home / Forms / Upper Extremity Functional Scale
 

Upper Extremity Functional Scale

Instructions

We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your upper limb problem for which you are currently seeking attention. Please provide an answer for each activity.

Today, do you or would you have any difficulty at all with:

HIPAA Consent
Although this form is dual encrypted using SSL & GnuPG, there is the slight possibility that this communication can be intercepted in transmission, decrypted, or misdirected. Your use of email to communicate protected health information to us indicates that you acknowledge and accept the possible risks associated with such communication. 

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19 West 21st St, Suite 404

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Physical Therapy Associates of New York

19 West 21st Street, Suite 404
New York, NY 10010

212 366-4450
info@ptany.com

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