Product Manual

6
BASELINE
®
SCOLIOSIS METER - SCHOOL WORKSHEETS
STUDENT NAME ADDRESS Date of Examination Examination Results Physician Follow-up 5th Grade/Age Remarks: 6th Grade/Age Remarks: 7th Grade/Age Remarks: 8th Grade/Age Remarks: 9th Grade/Age Remarks: 10th Grade/Age Remarks: 11th Grade/Age Remarks: 12th Grade/Age Remarks:
SHOULDER TILT PELVIC TILT LUMBAR ROTATIONAL DEVIATION
Degrees Centimeters/Millimeters (in) Degrees Centimeters/Millimeters (in) 5th 6th 7th 8th 9th 10th 11th 12th
THORACIC DEVIATION IN POSTERIOR RIB CAGE ANTERIO-POSTERO DEVIATION Degrees Centimeters/Millimeters (in) OF L5-APEX OF SACRUM
Centimeters/Millimeters (in) Normal = 1.3 cm (5.11 in) 5th 6th 7th 8th 9th 10th 11th 12th SPINAL ANALYSIS OF ANTERIO-POSTERO CURVES Centimeters/Millimeters (in) Cervical Curve Thoracic Curve Normal = 1.3 cm (5.11 in) Normal = 1.3 cm (5.11 in) 5th 6th 7th 8th 9th 10th 11th 12th
School Nurse