Start
hcs_2_clinic_4
HERTFORDSHIRE 31-39
CHAIR RISES & FLAMINGO STANDS

Name

Name
CHAIR RISES

Able to perform test

1
Yes
2
No
If NO,
qc_i == 2

reason

1
Balance difficulties
2
Other Specify
Other

Test performed with walking aid

1
Yes
2
No
If YES,
qc_ii == 1

Type

1
Stick
2
Frame
3
Other Specify
Other

5 sit/stand rises completed?

1
Yes
2
No
If NO,
qc_iii == 2

how many completed? ... Sit/stand rises

How many

Time taken for sit/stand rises ... seconds

Time taken, seconds and 100ths of a second

Observer

Observer
FLAMINGO STANDS

Able to perform test

1
Yes
2
No
If NO,
qc_vi == 2

reason

1
Balance difficulties
2
Other Specify
Other

Timed one-legged stand (max. 30 seconds) ... seconds

Time taken, seconds and 100ths of a second

Observer

Observer
End

hcs_2_clinic_4

HERTFORDSHIRE 31-39
CHAIR RISES & FLAMINGO STANDS
Name
Name

CHAIR RISES

Able to perform test
1
Yes
2
No
reason
1
Balance difficulties
2
Other Specify
Other
Test performed with walking aid
1
Yes
2
No
Type
1
Stick
2
Frame
3
Other Specify
Other
5 sit/stand rises completed?
1
Yes
2
No
how many completed? ... Sit/stand rises
How many
Time taken for sit/stand rises ... seconds
Time taken, seconds and 100ths of a second
Observer
Observer

FLAMINGO STANDS

Able to perform test
1
Yes
2
No
reason
1
Balance difficulties
2
Other Specify
Other
Timed one-legged stand (max. 30 seconds) ... seconds
Time taken, seconds and 100ths of a second
Observer
Observer
Name

Chair Rises & Flamingo Stands