Foot Function and 3-Box Gait Report ErgoTEC Tecnologico de Costa Rica
Patient Claudia Sanchez Name
Page 1 of 4 Claudia Sanchez Date Printed: 6/4/2018
Patient ID
123
DOB
15/12/2001
Date of Exam
6/4/2018
Time of Exam 4:39p. m. Examiner Alberto Sanchez Alvarado
Date of Exam
6/4/2018
Time of Exam 4:48p. m. Examiner
Gender F
Comparison of Exam Results: Left Foot Exam 6/4/2018, 4:39p. m.
Right Foot Con plantilla
Exam 6/4/2018, 4:39p. m.
Con plantilla
Foot Function and 3-Box Gait Report ErgoTEC Tecnologico de Costa Rica
Page 2 of 4 Claudia Sanchez Date Printed: 6/4/2018
Comparison of Exam Results: Exam 6/4/2018, 4:39p. m.
Exam 6/4/2018, 4:48p. m.
Foot Function and 3-Box Gait Report ErgoTEC Tecnologico de Costa Rica
Comparison of Exam Results:
Page 3 of 4 Claudia Sanchez Date Printed: 6/4/2018
Foot Function and 3-Box Gait Report ErgoTEC Tecnologico de Costa Rica
Patient Name: Patient ID: DOB: Gender:
Page 4 of 4 Claudia Sanchez Date Printed: 6/4/2018
Claudia Sanchez 123 15/12/2001 F
Comments and Observations
Signed:
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Dated:
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