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Posture Evaluation Form Template for Indonesia

A comprehensive clinical documentation tool designed to assess and record an individual's postural alignment, musculoskeletal condition, and related physical characteristics. This form, compliant with Indonesian healthcare regulations including Law No. 36 of 2009 on Health and relevant occupational health guidelines, provides a standardized approach to evaluating posture in both clinical and workplace settings. It includes detailed sections for static and dynamic posture assessment, measurements, and recommendations, serving as both a clinical record and a baseline document for tracking postural changes over time.

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What is a Posture Evaluation Form?

The Posture Evaluation Form serves as a critical tool in Indonesian healthcare and occupational health settings, designed to meet the requirements of Law No. 36 of 2009 on Health and Minister of Manpower Regulation No. 5 of 2018. This document is essential when conducting detailed postural assessments for various purposes, including clinical evaluation, workplace ergonomic assessment, and rehabilitation monitoring. The form captures comprehensive information about an individual's postural alignment, musculoskeletal status, and related physical conditions, providing healthcare providers with a standardized method for assessment and documentation. It is particularly valuable in cases requiring ongoing monitoring, workplace adaptation, or rehabilitation planning, and serves as a legal record of physical assessment in accordance with Indonesian healthcare documentation standards.

What sections should be included in a Posture Evaluation Form?

1. Patient Information: Basic demographic data including name, age, gender, occupation, and contact details

2. Assessment Date and Evaluator Details: Date of evaluation, name and credentials of the evaluator, facility information

3. Medical History: Relevant medical history, current symptoms, previous injuries or conditions affecting posture

4. Current Complaints: Present postural issues, pain areas, and related symptoms

5. Static Posture Assessment: Evaluation of standing posture from anterior, posterior, and lateral views

6. Dynamic Posture Assessment: Observation of posture during basic movements and functional activities

7. Measurements: Specific measurements including angles, distances, and deviations from normal alignment

8. Pain Assessment: Pain locations, intensity, and patterns related to postural issues

9. Findings Summary: Summary of key findings and postural abnormalities identified

10. Recommendations: Proposed interventions, exercises, or further assessments needed

What sections are optional to include in a Posture Evaluation Form?

1. Workplace Ergonomic Assessment: Additional section for patients requiring workplace posture evaluation

2. Sports/Activity-Specific Assessment: For athletes or individuals involved in specific physical activities

3. Progress Comparison: Section for comparing current findings with previous assessments

4. Photo Documentation: Section for including postural photographs with patient consent

5. Gait Analysis: Detailed walking pattern assessment when relevant to postural issues

What schedules should be included in a Posture Evaluation Form?

1. Body Diagram: Anatomical diagrams for marking posture deviations and pain locations

2. Measurement Charts: Standard charts for recording specific postural measurements

3. Exercise Protocol: Recommended exercises with illustrations if applicable

4. Follow-up Schedule: Recommended timeline for reassessment and progress monitoring

5. Consent Forms: Required patient consent forms for assessment and photo documentation

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok成人版 | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents

Jurisdiction

Indonesia

Document Type

Evaluation Form

Cost

Free to use

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