PRE-TEST
(prior to delivery)

Step 1 Step 2 Step 3 Step 4

Ask the patient to sign the
HIPAA Release Form

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)

If your patient has never used an iPad, please provide them with this brief iPad demo:

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.