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AMPS Score Form for OT Evaluation

This document contains two pages from an AMPS (Assessment of Motor and Process Skills) score form. The first page collects information about the client such as name, diagnosis, and date. It also includes sections to rate the client's quality of performance and ability to live independently during a given task. The second page contains items to score the client's motor and process skills on a scale from 1 to 4 during the observed task.

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Aymen Dabboussi
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© © All Rights Reserved
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2K views2 pages

AMPS Score Form for OT Evaluation

This document contains two pages from an AMPS (Assessment of Motor and Process Skills) score form. The first page collects information about the client such as name, diagnosis, and date. It also includes sections to rate the client's quality of performance and ability to live independently during a given task. The second page contains items to score the client's motor and process skills on a scale from 1 to 4 during the observed task.

Uploaded by

Aymen Dabboussi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

AMPS SCORE FORM (page 1 of 2)

Name: _____________________________________________ OTAP ID number: ___________________________________

Occupational therapist: ______________________________

Gender: ____ Male ____ Female Major diagnosis: ____________________________________

Birth date: _________________________________________ Secondary diagnosis: _______________________________

Evaluation date: _____________________________________ Observation number: ____ 1 ____ 2 ____ 3 ____ 4

Task number: ________ Task name: ________________________________________________________________________

RATE THE PERSON’S QUALITY OF PERFORMANCE (QoP) ON THIS TASK:

No Questionable Minimal Moderate Marked Inordinate;


problem cannot test

Increased effort 1 2 3 4 5 6

Decreased efficiency 1 2 3 4 5 6

Decreased safety 1 2 3 4 5 6

Assistance provided 1 2 3 4 5 6

GLOBAL BASELINE STATEMENT: __________________________________________________________________________

_______________________________________________________________________________________________________

________________________________________________________________________________________________________

RATE THE PERSON’S OVERALL ABILITY TO LIVE IN THE COMMUNITY (Consider everything you know about the person):

____The person can/could live independently

____The person needs/should have minimal assistance or supervision

____The person needs/should have moderate to maximal assistance

NOTES:

(This page may be photocopied)


AMPS SCORE FORM (page 2 of 2)
ITEM RAW SCORES
ADL Motor Skills ADL Process Skills

BODY POSITION SUSTAINING PERFORMANCE

1. Stabilizes 4 3 2 1 16. Paces Already scored under ADL motor skills

2. Aligns 4 3 2 1 17. Attends 4 3 2 1

3. Positions 4 3 2 1 18. Heeds 4 3 2 1

OBTAINING AND HOLDING OBJECTS APPLYING KNOWLEDGE

4. Reaches 4 3 2 1 19. Chooses 4 3 2 1

5. Bends 4 3 2 1 20. Uses 4 3 2 1

6. Grips 4 3 2 1 21. Handles 4 3 2 1

7. Manipulates 4 3 2 1 22. Inquires 4 3 2 1

8. Coordinates 4 3 2 1 TEMPORAL ORGANIZATION

MOVING SELF AND OBJECTS 23. Initiates 4 3 2 1

9. Moves 4 3 2 1 24. Continues 4 3 2 1

10. Lifts 4 3 2 1 25. Sequences 4 3 2 1

11. Walks 4 3 2 1 26. Terminates 4 3 2 1

12. Transports 4 3 2 1 ORGANIZING SPACE AND OBJECTS

13. Calibrates 4 3 2 1 27. Searches/ 4 3 2 1


Locates

14. Flows 4 3 2 1 28. Gathers 4 3 2 1

SUSTAINING PERFORMANCE 29. Organizes 4 3 2 1

15. Endures 4 3 2 1 30. Restores 4 3 2 1

16. Paces 4 3 2 1 31. Navigates 4 3 2 1

ADAPTING PERFORMANCE

32. Notices/ 4 3 2 1
Responds

33. Adjusts 4 3 2 1

34. Accommodates 4 3 2 1

35. Benefits 4 3 2 1

(This page may be photocopied)

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