BOPDHB Patient Resources Hip and Knee joint replacement book - June 2016 | Page 26

Before coming to hospital

Toilet

Height

cm

Measure from the top of the ceramic bowl
to the floor (do not include the seat)
Are there rails fitted?
If yes, where
Is there equipment fitted?
If yes, list:

House
Steps into the house? – if yes how many
Level inside ?
If no, how many stairs?
List Equipment required: (√ if issued)

Shower

Over Bath 
Are there rails fitted?
If yes, where

Cubicle  Wet Area / Level 

Is there equipment fitted?
If yes, list:

*Bath / *Shub *(circle)
Height of Bath Side

cm

Width of the bath rim (i.e. next to the wall)

cm

Are there rails fitted? If yes, where
Is there equipment fitted? If yes, list:
To be completed by the Occupational Therapist

Popliteal to floor:
Signed:
24

Date:

cm Optimum Height:
Name of Therapist:

cm