House Call Consents Welcome Packet - Printable PDF Consent Medical History Form Therapy Care Management Data Entry Form FRFT - Full Range Functional Tool (PSFS) Waiver of Liability (DME) Outpatient Consents Outpatient Consent - Insurance Consent Form - Private Pay Medical History Form Home Health Consents Do Not Use- Home Health SOC - FULL - For both HC and OP - Please complete the Patient Specific Functional Scale for ALL Outpatient & House Call patient at Eval and Discharge. FRFT - Full Range Functional Tool (PSFS) HC and OP Functional Tests (As Needed) LEFS - Lower Extremity Functional Scale NDI - Neck Disability Index ODI - Oswestry DASH - Disability of the Arm, Shoulder and Hand UEFS - Upper Extremity Functional Scale FAAM - Foot and Ankle Ability Measure
