Patients Condition definition
Patients Condition. Recovered Improved Unchanged The patient is: Ambulatory Bed Confined House Confined If Hospital Confined, please provide the following hospital information: Dates Confined from: through Hospital Name: Address: Functional Capacity: If the claim is for loss of sight, what is the patient’s visual acuity? Class 1 No Limitations Class 2 Slight Limitations Is the loss total and permanent? Yes No Class 3 Marked Limitations Is the loss due to the accident? Yes No Class 4 Complete Limitations If so, to what degree? Blood Pressure (last visit):