Initial medical encounter for this Weight bearing? Documentation of bony tenderness: X-Ray If no x-ray ordered, ordered? was there appropriate Yes, tender injury, AND Yes, foot documentation for a No, not tender Student does not have any sensory follow-up plan? Yes, ND, not documented defects of extremities Yes No No Not applicable Medical Chart Date of visit At time of At time of At the At the lateral At the 5th At the # (continued) injury? evaluation? medial malleolus? metatarsal navicular malleolus? head? bone? 10 11 12 13 14 15 16 17 18
Initial medical encounter for this injury, AND Student does not have any sensory defects of extremities Weight bearing? Documentation of bony tenderness: Yes, tender No, not tender ND, not documented X-Ray ordered? Yes, foot Yes, No If no x-ray ordered, was there appropriate documentation for a follow-up plan? Yes No Not applicable Medical Chart # (continued) Date of visit At time of injury? At time of evaluation? At the medial malleolus? At the lateral malleolus? At the 5th metatarsal head? At the navicular bone? 10 11 12 13 14 15 16 17 18
Ottawa_Ankle_Rules_background_instructions_worksheet.docx