POST-TEST 2
(5-6 months after delivery)

Step 1 Step 2 Step 3 Step 4

Provide the patient with the
Patient Survey on the iPad


(Click image to access form)

Administer the Timed Up and Go. Record the results using the
TUG Form on the iPad


(Click image to access form)

Administer the Amputee Mobility Predictor. Record the results using the AMP Form on the iPad


(Click image to access form)

Complete the Mobility Status
Form on the iPad


(Click image to access form)

This will be your final study-related visit with this patient.

PLUS-M was created at the University of Washington. For more information, you can contact us at info@plus-m.org or 1-800-504-0564.