Brielle Orthopedics DASH Form

Hello! Welcome to the Disabilities of the Arm, Shoulder and Hand form. This form will be used by Brielle Orthopedics to quantify how well you have recovered from your orthopedic surgery. Please answer all questions and read all directions carefully.

    Dr. Brian M. Katt, M.D

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    Identification Questions

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    Multiple Choice Questions

    Please rate your ability to do the following activities in the last week by selecting the number below the appropriate response. If you have not performed the specified task within the last week, please consider your ability to perform the task if you had attempted it. Please leave a question BLANK (do not select any answers) if you would liike to omit or not answer the question. You may only do this a maximum of THREE(3) times, or else your score will not be calculated properly.
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    Symptom Related Questions

    Please rate the severity of the following symptoms during the last week:
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    Sleeping Ability

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    Agree/Disagree

    To what extent do you agree with or disagree with the following statement?
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