'<CPRS_TEMPLATE>'#$D#$A'  
<TEMPLATE NAME="HBPC KT NOTE">'#$D#$A'    
<TYPE>T</TYPE>'#$D#$A'    
<STATUS>A</STATUS>'#$D#$A'    
<BOILERPLATE_TEXT>'#$D#$A'      
<p>Patient History:{FLD:WORD-3}</p>'#$D#$A'      
0	<p></p>'#$D#$A'      
1	<p>S:{FLD:WORD-3}</p>'#$D#$A'      
2	<p></p>'#$D#$A'      
<p></p>'#$D#$A'      
<p>O:Current Status:</p>'#$D#$A'      
<p>AROM:'#9'Upper Extremity - (Degrees)      Right   Left</p>'#$D#$A'      
<p>     Shoulder Flexion - (180*)           {FLD:WORD FLD EDIT 5}'#9'{FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p>     Shoulder Extension - (60*)          {FLD:WORD FLD EDIT 5}'#9'{FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p>     Elbow Flexion - (150*)              {FLD:WORD FLD EDIT 5}'#9'{FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p>     Wrist Flexion - (80*)               {FLD:WORD FLD EDIT 5}'#9'{FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p>     Wrist Extension -                   {FLD:WORD FLD EDIT 5}'#9'{FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p>     Hand/Finger Flexion                 {FLD:WORD FLD EDIT 5}'#9'{FLD:WORD FLD EDIT 5}   </p>'#$D#$A'      
<p>     Hand/Finger Extension               {FLD:WORD FLD EDIT 5}'#9'{FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p>Comments:{FLD:WORD PROCESSING3}</p>'#$D#$A'      
<p></p>'#$D#$A'      
<p>Lower Extremity - (Degrees)              Right   Left</p>'#$D#$A'      
<p>   Hip Flexion - (120*)                  {FLD:WORD FLD EDIT 5}      {FLD:WORD FLD EDIT 5}'#9'</p>'#$D#$A'      
<p>   Hip Extension - (30*)                 {FLD:WORD FLD EDIT 5}      {FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p>   Knee Flexion - (135*)                 {FLD:WORD FLD EDIT 5}      {FLD:WORD FLD EDIT 5}'#9'</p>'#$D#$A'      
<p>   Ankle Dorsi flexion - (20*)           {FLD:WORD FLD EDIT 5}      {FLD:WORD FLD EDIT 5}'#9'</p>'#$D#$A'      
<p>   Ankle Plantar flexion - (50*)         {FLD:WORD FLD EDIT 5}      {FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p>Comments:{FLD:WORD PROCESSING3}</p>'#$D#$A'      
<p></p>'#$D#$A'      
<p>STRENGTH: SCALE (0=ZERO,1=TRACE,2=POOR,3=FAIR,4=GOOD,5=NORMAL)</p>'#$D#$A'      
<p>  General Strength                       Right   Left'#9'       </p>'#$D#$A'      
<p>    UE                                   {FLD:WORD FLD EDIT 5}'#9'{FLD:WORD FLD EDIT 5}                </p>'#$D#$A'      
<p>    Hand/Finger Flexion                  {FLD:WORD FLD EDIT 5}'#9'{FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p>    Hand/Finger Extension                {FLD:WORD FLD EDIT 5}'#9'{FLD:WORD FLD EDIT 5}                      </p>'#$D#$A'      
<p>    LE                                   {FLD:WORD FLD EDIT 5}'#9'{FLD:WORD FLD EDIT 5}      </p>'#$D#$A'      
<p>    Hip Extension                        {FLD:WORD FLD EDIT 5}'#9'{FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p>    Knee Extension                       {FLD:WORD FLD EDIT 5}'#9'{FLD:WORD FLD EDIT 5}              </p>'#$D#$A'      
<p>Comments:{FLD:WORD PROCESSING3}</p>'#$D#$A'      
<p></p>'#$D#$A'      
<p>BALANCE: SCALE (0=MAX ASSIST,P=MOD ASSIST,F=W/OUT ASSIST,G=MOD CHALLENGE,G+=MAX CHALLENGE,N=NORM)</p>'#$D#$A'      
<p>         Sitting - Static - {FLD:WORDFLD_EDIT_50}</p>'#$D#$A'      
<p>                  Dynamic - {FLD:WORDFLD_EDIT_50}</p>'#$D#$A'      
<p>        Standing - Static - {FLD:WORDFLD_EDIT_50}</p>'#$D#$A'      
<p>                  Dynamic - {FLD:WORDFLD_EDIT_50}</p>'#$D#$A'      
<p></p>'#$D#$A'      
<p>GAIT ANALYSIS:</p>'#$D#$A'      
<p>'#9'Assistive Device -{FLD:WORDFLD_EDIT_50}</p>'#$D#$A'      
<p>'#9'Distance Walked -{FLD:WORDFLD_EDIT_50}</p>'#$D#$A'      
<p>'#9'Deviation:{FLD:WORDFLD_EDIT_50}</p>'#$D#$A'      
<p>Comments:{FLD:WORD PROCESSING3}</p>'#$D#$A'      
<p></p>'#$D#$A'      
<p>SAFETY: Recent Falls:{FLD:YES, NO, *} While performing {FLD:WORDFLD_EDIT_50} </p>'#$D#$A'      
<p></p>'#$D#$A'      
<p>PAIN LEVEL:{FLD:WORD FLD EDIT 5} AREA:{FLD:WORDFLD_EDIT_50}</p>'#$D#$A'      
<p></p>'#$D#$A'      
<p>FUNCTIONAL INDEPENDENCE MEASURE (FIM)</p>'#$D#$A'      
<p></p>'#$D#$A'      
<p>Self-Care</p>'#$D#$A'      
<p> Eating              {FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p> Grooming            {FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p> Bathing             {FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p> Dressing-Upper Body {FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p> Dressing-Lower Body {FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p> Toileting           {FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p>Sphincter Control</p>'#$D#$A'      
<p> Bladder Management  {FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p> Bowel Management    {FLD:WORD FLD EDIT 5}</p>'#$D#$A'      
<p>Mobility</p>'#$D#$A'      
<p> Bed,Chair,Wheelchair{FLD:WORD FLD EDIT 5}</p>'#$D#$A'   '...              