Ability Gujarat - Administrative User Manual

“Ability Gujarat”
“ABILITY GUJARAT”
ADMINISTRATIVE MANUAL FOR
EVALUATION AND
CERTIFICATION OF DISABILITY
CERTIFICATES
Disability User Manual www.ability.gujarat.gov.in Page 1

Table of Content
Chapter Index Page No
Number
I Government Resolution No
II Circular
Chapter 1 What is “Ability Gujarat” Project 3–4
Chapter 2 Major Recommendations to simplify the Process of Certification 5
Chapter 3 Old Model VS New Model 5
Chapter 4 Disability Certification Process 6–7
Chapter 5 I. Guidelines for Evaluation of Various Disabilities
a. Mental Retardation 8
b. Visual Disability 8
c. Speech and Hearing Disability 9
d. Locomotor Disability 10
II.Revised Guidelines for Evaluation of the Permanent Physical
10 – 14
Impairment
1. Guidelines for Evaluation of Permanent Physical
14 – 16
Impairment of Upper Limb
16-18
Impairment in Lower Limb
16 – 20
Impairment of Trunk (Spine)
21
Impairment in Amputees
21 – 23
Impairment of Congenital Deficiencies of the Limbs
6. Guidelines for Evaluation of Physical Impairment in
24 – 25
Neurological Conditions
7. Guidelines for Evaluation of Physical Impairment due to
26 – 28
Cardiopulmonary Diseases
8. Guidelines for Evaluation of Physical Impairment due to
29
Cardiopulmonary Diseases
E. Multiple Disabilities
 Definition 30
 Guidelines for Evaluation 30
 Procedure for Certification of Multiple Disabilities 30
Chapter 6 Incentives and Concessions for PwDs 31 – 34
Appendix:
Appendix I Appendix I of Annexure A (Form A): Assessment Performa for
35 – 36
Upper Extremity
Appendix I of Annexure A (Form B): Assessment Performa for
37 – 38
Lower Extremity
Appendix II Annexure B: Ready Reckoner Table 39 – 41
Annexure I GR No HSP 102002-GOI-36-A Dept of H & FW - Govt of
42 - 54
Gujarat, dated 26/10/2010

Chapter 1: What is Ability Gujarat Project

“All human beings are born free and equal in dignity and rights.” Human rights contribute
to address the challenges faced by persons with disabilities. And it is inextricably linked to our
central mandate of human development, including the Millennium Development Goals
(MDGs).
As per the National Sample Survey Organization, survey of 1991estimates around 1.9 % of
populations are disabled in India, and according to the census of 2001 there are 2.13 % of
populations are disabled in India and the prevalence of disability in Gujarat state is 2.1 %. As
per the estimated prevalence rate, the estimated population of Persons with Disability (PwDs) in
the Gujarat state would be around 12 Lakhs.
PwDs are one of the most marginalized segments of society when it comes to service delivery;
so it became necessary to develop a system as a result of which PwDs get the entitled disability
certificates with ease and convenience. Since one of the important functions of State Health
department is to issue necessary disability certificate to Persons with Disability (PwD) as per
the extant guidelines issued by Ministry of Social Justice and Empowerment.
At present, Department of SJED and Health& Family Welfare, Gujarat does not have a system
of comprehensive database on total number of Persons with Disability (PwDs) identified and
issued disability certificate in the State. Although these services are being rendered at respective
levels but a comprehensive database at state level is yet to be created, managed and maintained
as an integral part of the system for disable friendly governance. The Department of Health &
Family Welfare, Gujarat is committed towards the said cause and is pro-actively taking actions
to ensure that Persons with Disability (PwDs) can exercise their rights and avail entitlements.
To address this gap, a web based application named “Ability Gujarat” is developed. ‘Ability
Gujarat’, is innovative as it is intended to harness the benefits of ICT to improve effective and
efficient delivery of services to PwDs. The project has been designed to cover the entire state of
Gujarat. The key component of the project is to identify Persons with Disability (PwDs) and
undertake issuance of “disability certificates” to the individuals within a specified time period.
Features of Ability Gujarat:
• Scientific assessment of degree of the disability based on guidelines and formulae.

• Generation of a computer based Disability Certificate with unique ID along with
Identity Card.
• Will provide details of support services for disabled person
• The database thus generated will be hosted in the Public Domain which can be accessed
online.
• Query Module will help us to retrieve the information in desired format.
• Online analytical reports of various parameters related to PwDs can be generated

Persons with Disability (PwDs) can avail the benefits of “Ability Gujarat” project through
following work flow
• Direct online registration from website ( www.abilitygujarat.in )

• Registration through NGOs- using website/manual forms
• Manual forms filled by Health workers
Registration • Applications send by postal services
• PwD can visit nearby Public Health Facility for assessment

• Doctor will varify the legal documents and perform physical
Physical asssessment of disability
Assessment
• If degree of disability is more than 40% - certificate will be issued

• otherwise rejection of certificate will be done
Issuance / rejection
of Certificate
Features of Ability Gujarat:

• Scientific assessment of degree of the disability based on guidelines and formulae.
• Generation of a computer based Disability Certificate with unique ID along with

Identity Card.
• Will provide details of support services for disabled person
• The database thus generated will be hosted in the Public Domain which can be accessed
online.
• Query Module will help us to retrieve the information in desired format.
• Online analytical reports of various parameters related to PwDs can be generated
Benefits of the Ability Gujarat:

• Centralized database will be helpful for effective camp approach
• Efficient services at hospitals due to digitalization of records
• Real-time Information about PwDs
• Easy to avail disability certificate due to Fixed Day and Fixed time approach
• Reduced per visit time and Less waiting time for the certificate
• Longer life of Disability records
• Improvement in the quality of life of PwDs
Chapter 2: Major Recommendations to simplify the Process

of Certification
Chapter 3: Old Model v/s New Model
Before Recommendation After Recommendation
Earlier, only specialists (Medical College & Medical Officer (SDH, CHC and PHC) can
District Hospital) used to ascertain the issue disability certificate for the obvious
disability of a person based on the guidelines disability
and their discretion and issue the certificate.
Previously Three member Medical Board was Board is replaced by a single specialist doctor
there to issue the certificate (For Non (For Non oblivious single disabilities)
oblivious single disabilities)
Previously only Government Specialists were Government Institutions like
allowed for issuance of certificate DH/SDH/CHC/PHC are authorized for taking
services of non- governmental specialists and
testing facilities in case these are not available
in government health care facility.

Chapter 4: Disability Certification Process
1. The minimum degree of disability should be 40% in order to be eligible for any disability
certificate.
2. Medical authorities are designated to issue the certificate for different type of disabilities.
S.No Type of Health Care Facility to Authorized person to Appellate Body

Disability issue Disability issue Disability (In case of
Certificate Certificate Controversy arises
on percentage of
Disability given by
Doctor)
1 (a) Locomotor District Hospital/Sub CDMO of District CDMO cum Civil
Disability District Hospital/Govt. Hospital/RMO of Surgeon
Dispensary/ CHC/PHC District
Hospital/Superintendent
of Sub District
Hospital/RMO of Sub
District
of CHC/MO of PHC
(b) Blindness District Hospital/Sub CDMO of District CDMO cum Civil
District Hospital/Govt. Hospital/RMO of Surgeon
Dispensary/ CHC/PHC District
of Sub District
Hospital/RMO of Sub
District
of CHC/MO of PHC
2 Multiple Any District Hospital/Sub Medical Board under District Medical
Disability District Hospital/CHC the Chairmanship of Board
where Specialist doctors (CDMO in the District

are available and also Hospital/Superintendent

Assessment/Management/ in the Sub District
Evaluation and testing Hospital), senior
facility for Disability is specialist doctor and
available concerned specialist.
3 Single non- Any District Hospital/Sub Single Specialist doctor District Medical
obvious District Hospital/CHC in the concerned Board
Disability where Specialist doctors disability subject.
are available and also
Assessment/Management/
Evaluation and testing
facility for Disability is
available
4 Other disability Any District Hospital/Sub Medical Board under District Medical
except District Hospital/CHC the Chairmanship of Board
Locomotor where Specialist doctors (CDMO in the District
disability, are available and also Hospital/Superintendent
blindness and Assessment/Management/ in the Sub District
Multiple Evaluation and testing Hospital), senior
disability facility for Disability is specialist doctor and
available concerned specialist.
3. Head of the government institutions like DH/SDH/CHC/PHC are authorized for taking
services of non- governmental specialists and testing facilities in case these are not
available in government health care facility.
4. The certificate would be valid for a period of five years for those whose disability is
temporary. For those who acquire permanent disability the validity can be shown as
permanent.
5. If the disability certificate is issued by the private doctor then counter signature of MO
PHC/Superintendent of CHC/Superintendent of Sub District Hospital/CDMO of District
Hospital is essential to make the certificate valid.

Chapter 5: (I) Guidelines for Evaluation of Various

Disabilities
A. MENTAL RETARDATION
1. Definition - Mental retardation is a condition of arrested or incomplete development of the

mind, which is especially characterized by impairment of skills manifested during the
development period which contribute to the overall level of intelligence, i.e., cognitive,
language, motor and social abilities.
2. Categories of Mental Retardation

2.1. Mild Mental Retardation - The range of 50 to 69 (standardized IQ test) is indicative of
mild retardation. Understanding and use of language tend to be delayed to a varying degree and
executive speech problems that interfere with the development of independence may persist into
adult life.
2.2. Moderate Mental Retardation - The IQ is in the range of 35 to 49. Discrepant profiles of
abilities are common in this group with some individuals achieving higher levels in visuo-
spatial skills than in tasks dependent on language while others are markedly clumsy by enjoy
social interaction and simple conversation. The level of development of language in variable:
some of those affected can take part in simple conversations while others have only enough
language to communicate their basic needs.
2.3. Severe Mental Retardation - The IQ is usually in the range of 20 to 34. In this category,
most of the people suffer from a marked degree of motor impairment or other associated deficits
indicating the presence of clinically significant damage to or mal development of the central
nervous system.
2.4. Profound Mental Retardation - The IQ in this category estimated to be under 20. The ability
to understand or comply with requests or instructions are severally limited. Most of such
individuals are immobile or severally restricted in mobility, incontinent and capable at most of
only very rudimentary forms of non-verbal communication. They possess little or no ability to
care for their own basic needs and require constant help and supervision.
B. VISUAL DISABILITY
1. Definition - Blindness refers to a condition where a person suffers from any of the condition,
namely
I. total absence of sight; or

ii. Visual acuity not exceeding 6/60 or 20/200 (snellen) in the better eye with best correcting
lenses; or
iii. Limitation of field of vision subtending an angle of 20 degree or worse

2. Low Vision - Persons with low vision means a person with impairment of vision of less than
6/18 to 6/60 with best correction in the better eye or impairment of field in any one of the
following categories:-
i. Reduction of fields less than 50 degrees

ii. Hemianopia with macular involvement
iii. Altitudinal defect involving lower fields
3. Categories of Visual Disability

All with correction
% age
Category Better eye Worse eye impairment
Category 0 6/9-6/18 6/24 to 6/36 20%
Category I 6/18-6/36 6/60 to Nil 40%
6/40-4/60 or field of vision
Category II 3/60 to Nil 75%
10° -20°
3/60 to 1/60 or field of
Category III F.C. at 1 ft. to Nil 100%
vision 10°
F. C. at 1 ft. to Nil or field of
Category IV F.C. at 1 ft. to Nil 100%
vision 10°
One eyed F.C. at 1 ft. to Nil or field of
6/6 30%
persons vision 10°
Note: F.C. means finger count
C. SPEECH & HEARING DISABILITY
1. Definition of Hearing: - A persons with hearing impairment having difficulty of various

degrees in hearing sounds is an impaired person.
2. Categories of Hearing Impairment
Type of Speech % age of

Category DB Level
Impairment discrimination impairment
Mild hearing DB 26 to 40 dB in 80 to 100% in
I Less than 40%
Impairment better ear better ear
41 to 60 dB in better 50 to 80% in better
II (a) Moderate hearing 40% to 50%
ear ear
II (b) 61 to 70 dB hearing
Serve hearing 40 to 50% in better 51% to 70%
Impairment in better
impairment ear
ear
Profound hearing Less than 40% in 71% to 100%
III(a) 71 to 90 dB
Impairment better ear
91 dB and above in Very Poor
III(b) Total deafness 100%
better ear to hearing discrimination

i. Pure tone average of learning in 500, and 2000 HZ, 4000 HZ by conduction (AC and
BC) should be taken as basis for consideration as per the test recommendations.
ii. When there is only as island of hearing present in one or two frequencies in better ear, it
should be considered as total loss of hearing.
iii. Wherever there is no response (NR) at any of the 4 frequencies (500, 1000, 2000 and 4000
HZ), it should be considered as equivalent to 100 dB loss for the purpose of classification of
disability and in arriving at the average.
D. LOCOMOTOR DISABILITY
1. Definition:-
i. Impairment: An impairment in any loss or abnormality of psychological, physiological or
anatomical structure or function in a human being.
ii. Functional Limitations: Impairment may cause functional limitations which are partial or
total inability to perform those activities, necessary for motor, sensory or mental function within
the range or manner of which a human being is normally capable.
iii. Disability: A disability, is any restriction or lack resulting from an impairment) of ability to
perform an activity in the manner or within the range considered normal for a human being.
iv. Locomotor Disability: Locomotor disability is defined as a person’s inability to execute

distinctive activities associated with moving both himself and objects, from place to place and
such inability resulting from affliction of musculoskeletal and/or nervous system.
II. REVISED GUIDELINES FOR EVALUATION OF THE PERMANENT PHYSICAL

IMPAIRMENT
1. Guidelines for Evaluation of Permanent Physical Impairment of Upper Limb

1. The estimation of permanent impairment depends upon the measurement of functional
impairment and is not expression of a personal opinion.
2. The estimation and measurement should be made when the clinical condition has reached the
stage of maximum improvement from the medical treatment. Normally the time period is to be
decided by the medical doctor who is evaluating the case for issuing the PPI Certificate as per
standard format of the certificate.
3. The upper limb is divided into two component parts; the arm component and the hand
component.
4. Measurement of the loss of function of arm component consists of measuring the loss of
motion, muscle strength and co-ordinated activities.
5. Measurement of loss of function of hand component consists of determining the prehension,

sensation and strength. For estimation of prehension opposition, lateral pinch cylindrical grasp,
spherical grasp and hook grasp have to be assessed as shown in Hand Component of Form A
Assessment Performa for upper extremity.

6. The impairment of the entire extremity depends on the combination of the functional
impairments of both components
1.2 ARM COMPONENT
Total value of arm component is 90%
1.2.1 Principles of evaluation of range of motion (ROM) of joints

1. The value of maximum ROM in the arm component is 90%
2. Each of the three joints of the arm is weighed equally (30%;
Example:
The intra articular fractures of the bones of right shoulder joint may affect range of motion even
after healing. The loss of ROM should be calculated in each arc of motion as. envisaged in the
Assessment Form A (Assessment Proforma for Upper Extremity).
Arc of ROM Normal value Active ROM Loss of ROM

Shoulder Flexion 0-220 110 50%
Rotation 0-180 90 50%
Abduction-Adduction 0-180 90 50%
Hence the mean loss of ROM of shoulder will be 50+50+50/3 =150/3 = 50%
Shoulder movements constitute 30% of the motion of the arm component, therefore the loss of
motion for arm component will be 50 X 0.3d = 15% If more than one joint of the arm is
involved the loss of percentage in each joint is calculated separately as above and then added
together.
1.2.2. Principles of evaluation of strength of muscles:
1. Strength of muscles can be tested by manual method and graded from 0-5 as advocated by
Medical Research Council of Great Britain depending upon the strength of the muscles.
2. Loss of muscle power can be given percentages as follows:
Manual muscle Strength Lo ss of Strength in

grading percentage
0 100%
1 80%
2 60%
3 40%
4 20%
5 0%

3. The mean percentage of loss of muscle strength around a joint is multiplied by 0.30.
4. If loss of muscle strength involves more than one joint the mean loss of percentage in each
joint is calculated separately and then added together as has been described for loss of motion.
1.2.3 Principles of evaluation of coordinated activities:
1. The total value for coordinated activities is 90%

2. Ten different coordinated activities should be tested as given in Form A.
3. Each activity has a value of 9%
1.2.4 Combining values for the Arm Component:
The total value of loss of function of arm component is obtained by combining the value of loss
of ROM, muscle strength and coordinated activities, using the combing formula.
a + (b(90-a)/90) where a = higher value and b = lower value
Example
Let us assume that an individual with an intra articular fracture of bones of shoulder joint in
addition to 16.5% loss of motion in arm has 8.3% loss of strength of muscles and 5% loss of
coordination. These values should be combined as follows:
Loss of ROM - 16.5% 16.5+8.3(90-16.5)
Loss of strength of muscles - 8.3% To add = 23.33%
Loss of coordination - 5% 23.3+5(90-23.3)/90=27.0%
So the total value of loss of function in Arm component will be 27.0%
1.3 HAND COMPONENT:
1. Total value of hand component is 90%
2. The functional impairment of hand is expressed as loss of prehension, loss of sensation and
loss of strength
1.3.1 Principles of evaluation of prehensile:
Total value of prehensile is 30%
It includes:
a) Opposition - 8%
Tested against - Index finger - 2%
- Middle finger - 2%
- Ring - 2%
- Little finger - 2%
b) Lateral pinch -5% - Tested by asking the patient to hold a key between the thumb and lateral
side of index finger.
c) Cylindrical grasp - 6% Tested for
i. Large object of 4 inches size - 3%
ii. Small object of 1 inch size - 3%
d) Spherical grasp -6% Tested for
i. Large object of 4 inches size - 3%
ii. Small object of 1 inch size - 3%
e) Hook grasp - 5% -Tested by asking the patient to lift a bag

1.3.2. Principles of Evaluation of sensation:

1. Total value of sensation in hand is 30%.
2. It should be assessed according to the distribution given below
i. Complete loss of sensation

Thumb ray 9%
Index finger 6%
Middle finger 5%
Ring finger 5%
Little finger 5%
ii. Partial loss of sensation: Assessment should be made according to percentage of loss of
sensation in thumb/finger(s)
1.3.3. Principles of Evaluation of strength
1. Total value of strength is 30%.

2. It includes:
i. Grip strength 20%
ii. Pinch strength 10%

Strength of hand should be tested with hand dynamo-meter or by clinical method (grip method).
Additional weightage - A total of 10% additional weightage can be given to following
accompanying factors if they are continuous and persistent despite treatment
1. Pain
2. Infection
3. Deformity
4. Mat-alignment
5. Contractures
6. Cosmetic disfiguration
7. Dominant extremity-4%
8. Shortening of upper limb
First 1" - No weightage

For each 1" beyond first 1" -2%
The extra points should not exceed 10% of the total Arm Component and total PPI should not
exceed 100% in any case.
1.3.4. Combining values of hand component:

The final value of loss of function of hand component is obtained by summing up values of loss
of prehension, sensation and strength.
1.3.5. Combining values for the Extremity:

Values of impairment of arm component and impairment of hand component should be added
by using combining formula:
a + (b(90-a)/90)
Where a = higher value and b = lower value

Example:
Impairment of Arm - 27% 64+27(90-64)/90

Impairment of hand - 64% =71.8%
The total value can also be obtained by using the Ready Recknoer table for combining formula
given at Appendix.ll
2. Guidelines for Evaluation of permanent physical Impairment in Lower Limb.
The measurement of loss of function in lower extremity is divided into two components:
Mobility and standing components
2.1 MOBILITY COMPONENT

Total value of mobility component is 90%
It includes range of movement (ROM) and muscle strength
2.1.1. Principles of Evaluation of Range of Movement:

1. The value of maximum range of movement in mobility component is 90%
2. Each of three joints i.e. hip, knee and foot-ankle component is weighed equally - 30%.
Example:
A fracture of right hip joint bones may affect range of motion of the hip joint. Loss of ROM of
the affected hip in different are should be assessed as given in Form B (Assessment Proforma
for lower extremity).
Affected Joint - Rt. Hip:
Manual muscle Strength grading Loss of Strength in percentage

0 100%
1 80%
2 60%
3 40%
4 20%
5 0%
Arc of Movement Normal ROM Active ROM Loss in percentage

Flexion-Extension 0-140 70 50%
Abduction-Adduction 0-90 60 33%
Rotations 0-90 30 66%
Mean loss of ROM of Rt Hip = (50+33+66)/3 = 50%

Since the hip constitute 30% of the total mobility component of the lower limb the loss of
motion in relation to the lower limb will be 50 x 0.30=15%
If more than one joint of the limb is involved the mean loss of ROM in percentage should be
calculated in relation to individual joint separately and then added together as follows to
calculate the loss of mobility component in relation to that particular limb.

Example
Mean loss of ROM of Rt. Hip: 50%

Mean loss of ROM Rt. Knee: 40%
Loss of mobility component of Rt. Lower Limb will be: (50 x 0.30) + (40 x 0.30) = 27%
2.1.2. Principle of Evaluation of Muscle Strength:
1. The value for maximum muscle strength in the limb is 90%
2. Strength of muscles can be tested by Manual Method and graded 0-5 as advocated by MRC
of Great Britain depending upon the residual strength in the muscle group.
3. Manual muscle grading can be given percentage like below:
Power Grade of Ms Loss of strength in percentage

0 100
1 80
2 60
3 40
4 20
5 0
4. Mean percentage of muscle strength loss around a joint is multiplied by 0.30 to calculate loss
in relation to limb
5. If there has been a loss muscle strength involving more than one joint the values are added as
has been described for loss of ROM
2.1.3. Combining values for mobility component:

1. The values of loss of ROM and loss of muscle strength should be combined with the help of
combining formula: a+b(90-a)/ 90 (a = higher value, b = lower value)
Example:
Let us assume that the individual with a fracture of right hip bones has in addition to 16% loss
of motion, 8% loss of muscle strength also.
Combined values
Motion-16%: 16+8(90-16)/ 90
Strength-8% =22.6%

2.2 STABILITY COMPONENT
1. Total value of the stability component is 90%
2. It should be tested by clinical method as given in From B (Assessment Proforma for lower
extremity). There are nine activities, which need to be tested, and each activity has a value of
ten per cent (10%). The percentage valued in relation to each activity depends upon the
percentage of loss stability in relation to each activity.
2.3 EXTRA POINTS
Extra points have been given for pain, deformities, contractures, loss of sensations and
shortening Maximum points to be added are 10% (excluding shortening). Details are as
following.
In functional position 3%
i) Deformity
In non-functional position 6%
ii) Pain Sever(grossly interfering with function) 9%
Moderate (moderately inter-fering with function) 6%
Mild (mildly interfering with function) 3%
Complete Loss 9%
iii) Loss of sensation
Partial Loss 6%
First 1/2" Nil
iv) Shortening
Every 1/2" beyond first 1/2" 4%
Superficial complications
v) Complications 3%
Deep complications
3. Guidelines for Evaluation of Permanent Physical Impairment of Trunk (Spine)

Basic guidelines:
1. As permanent physical impairment caused by spinal deformity tends to change over the
years, the certificate issued in relation to spine should be reviewed as per the standard format of
the certificate given at Annexure -B of Appendix.III.
2. Permanent physical impairment should be awarded in relation to spine and not in relation to
whole body.
3. Permanent physical impairment due to neurological deficit in addition to spinal impairment
should be added by combining formula. The local effects of the lesions of the spine can be
conventionally divided into traumatic and non-traumatic. The percentage of PPI in relation to
each situation should be valued as follows:

3.1 TRAUMATIC LESIONS
Percentage of PPI
3.1.1 Cervical spine injuries in relation to
Spine
i) 25% or more compression of one or two adjacent vertebral bodies 20%
with No involvement of posterior elements, No nerve root involvement,
moderate Neck rigidity and persistent Soreness.
ii) Posterior element damage with radiological Evidence of moderate 10%
parties’ dislocation/subluxation including whiplash injury. 25%
A) With fusion healed, No permanent motor or sensory changes
B) Persistent pain with radiologically demonstrable instability.
iii) Severe Dislocation: 10%
a) Fair to good reduction with or without fusion with no residual motor 15%
or sensory involvement;
b) Inadequate reduction with fusion and persistent radicular pain
Percentage of PPI In
3.1.2. Cervical Intervertebral Disc Lesions
relation to Spine
i) Treated case of disc lesion with persistent pain and no
10%
neurological deficit
ii) Treated case with pain and instability 15%
3.1.3. Thoracic and Thoracolumbar Spine Injuries:
i) Compression of less than 50% involving one vertebral body with no neurological
10%
manifestation
ii) Compression of more than 50% involving single vertebra or more with involvement 20%
of posterior elements,healed, no neurological manifestations persistent pain, fusion
indicated
iii) Same as (b) with fusion, pain only on heavy use of back 15%
iv) Radiologically demonstrable instability with fracture or fracture dislocation with
30%
persistent pain.
3.1.3. Thoracic and Thoracolumbar Spine Injuries:
i) Compression of less than 50% involving one vertebral body with no neurological
10%
manifestation
ii) Compression of more than 50% involving singlevertebra or more with involvement 20%
of posterior elements, healed, no neurological manifestations persistent pain, fusion
indicated
iii) Same as (b) with fusion, pain only on heavy use of back 15%
iv) Radiologically demonstrable instability with fracture or fracture dislocation with
30%
persistent pain.

3.1.4 Lumbar and Lumbosacral Spine: Fracture
a)Compression of 25% or less of one or two adjacent Vertebral bodies, No definite

15%
pattern or neurological Deficit>
b)Compression of more than 25% with disruption of Posterior elements, persistent pain
30%
and stiffness, healed With or without fusion, inability to lift more than 10 kgs.
c)Radiologically demonstrable instability in low lumbar or Lumbosacral spine with
35%
pain
3.1 5 Disc lesion:
a)Treated case with persistent pain 15%

b)Treated case with pain and instability 20%
c)Treated case of disc disease with pain activities of lifting moderately modified 25%
d)Treated case of disc disease with persistent pain and stiffness, aggravated by heavy
30%
lifting necessitating modification of all activities requiring heavy weight lifting
3.2 NON TRAUMATIC LESIONS:

3.2.1 Scoliosis:
Basic guidelines - following modification is suggested:- The largest structural curve should be
accounted for while calculating the PPI and not the compensatory curve or both structural
curves.
3.2.2 Measurement of Spine Deformity:

Cobb's method for measurement, of angle of curve in the radiograph taken in standing position
should be used. The curves have been divided into following groups depending upon the angle
of major structural scoliotic deformity.
Group Cobb's Angle PPI in relation to Spine

I 0-20 NIL
II 21-50 10%
III 51-100 20%
IV 101 & above 30%
3.2.3 Torso Imbalance:
In addition to the above PPI should also be evaluated in relation the torso imbalance. The torso
imbalance should be measured by dropping a plumb line from C7 spine and measuring the
distance of plumb line from gluteal crease.
Deviation of Plumb line PPI

Upto 1.5 Cm 4%
1.6 - 30 Cm 8%
3.1 - 50 Cm 16%
5.1 and above 32%

3.2.4 Head Tilt over C7 spine PPI
Upto 15 4%
More than 15 10%
3.2.5 Cardiopulmonary Test
In cases with scoliosis of severe type cardiopulmonary function tests and percentage deviation
from normal should be assessed by one of the following method whichever seems more reliable
clinically at the time of assessment. The value thus obtained may be added by combining
formula.
a. Chest Expansion
a. Chest Expansion PPI

4 - 5 Cm. Normal
Less than 4 cm reduction in Chest expansion 5% for each cm
No expansion 25%
b. Counting in one breathe:
Breathe Count PPI

More than 40 Normal
0-40 5%
0-30 10%
0-20 15%
0-10 20%
Less than 5 25%
3.2.6 Associated Problems: To be added directly but the total value of PPI in relation to
spine should not exceed 100%.
a) Pain
-mildly interfering with ADL 4%

-moderately restricting ADL 6%
-severely restricting ADL 10%
b) Cosmetic Appearance:
-No obvious disfiguration with clothes on Nil

-mild disfigurement 2%
-severe disfigurement 4%

c) Leg Length Discrepancy:
-First1/2 " shortening Nil

-Every1/2" beyond first1/2" 4%
d) Neurological deficit - Neurological deficit should be calculated as per established method of

evaluation of PPI in such cases. Value thus obtained should be added telescopically using
combining formula.
3.3 KYPHOSIS
Evaluation should be done on the similar guidelines as use for scoliosis with the following
modifications:
3.3.1 Spinal Deformity PPI

Less than 20 Nil
21-40 10%
41-60 20%
Above 60 30%
3.3.2 Torso Imbalance - Plumb line dropped from external ear normally falls at ankle level.
The deviation from normal should be measured from ankle anterior joint line to the plumb line.
Less than 5 cm in front of ankle 4%

5 to 10 cm in front of ankle 8%
10 to 15 cm in front of ankle 16%
More than 15 cm in front of ankle 32%
(Add directly)
Miscellaneous conditions:
Those conditions of the spine which cause stiffness and pain etc. are rated as follows.
Percentage
Conditions
PPI
Subjective symptoms of pain, no involuntary muscle spasm,, not
A -0%
substantiated by demonstrable structural pathology
Pain, persistent muscles spasm and stiffness of spine, substantiated by
B -20%
mild radiological change.
C Same as B with moderate radiological changes -25%
Same as B with severe radiological changes involving any one of the
D -30%
regions of spine
E Same as D involving whole spine -40%

4. Guidelines for Evaluation of PPI in cases of Short Stature/Dwarfism:
1. Recumbent length or longitudinal height below 3rd percentile or less than 2 Standard
Deviation from the mean is considered to have short stature.
2. The evaluation of a Short Statured person should be considered only when it is of

disproportionate variety and is accompanied by an underlying pathological condition, e.g.,
Achondroplasia, Chandrodysplasi Punctata, spondyloepiphysical dysplasia, mucopoly and
acchrydosis, etc.
3. The ICMR norms as enclosed at Appendix III of Annexure. A should be used as a guideline
for the height.
4. Every 1" vertical height reduction should be valued as 4% permanent physical impairment.
5. Associated skeletal deformities should be evaluated, separately and total percentage of both
should be added by combining formula.
5. Guidelines for Evaluation of Permanent Physical Impairment in Amputees:

Basic Guidelines:
1. In cases of multiple amputees if the total sum of permanent physical impairment is above
100%, it should be taken as 100% only.
2. If the stump is unfit for fitting the prosthesis additional weightage of 5% should be added to
the value.
3. In case of amputation in more than one limb percentage of each limb is added by combining
formula and another 10% will be added but when only toes or fingers are involved only 5% will
be added
4. Any complication in form of stiffness of proximal joint, neuroma infection, etc., should be
given upto a total of 10% additional weightage. Dominant upper extremity should be given 4%
additional weightage.

PPI & loss of

Upper Limb Amputations physical
function of
each limb
1. Fore-quarter amputations 100%
2. Shoulder Disarticulation 90%
3. Above Elbow upto upper 1/3 of arm 85%
4. Above Elbow upto lower 1/3 of forearm 80%
5. Elbow disarticulation 75%
6. Below Elbow upto upper 1/3 of forearm 70%
7. Below Elbow upto lower 1/3 of forearm 65%
8. Wrist disarticulation 60%
9. Hand through carpal bones 55%
10. Thumb through C.M. or though 1st MC joint 30%
11. Thumb disarticulation through metacarpophalangeal Joint
25%
11. or through proximal phalanx.
12. Thumb disarticulation through inter phalangeal joint or Through
distal phalanx. 15%
12.
Index Middle Ring Little

Finger (15%) Finger (5%) Finger (3%) Finger (2%)
Amputation through
13. Proximal phalanx or
Disarticulation through 15% 5% 3% 2%
M.P. Joint
Amputation through
14. Middle phalanx or
Disarticulation through 10% 4% 2% 1%
PP joint.
Amputation through
15. Distal phalanx or
disarticulation through 5% 2% 1% 1%
DIP joint.

Lower Limb Amputations:
1. Hind quarter 100%

2. Hip disarticulation 90%
3. Above knee upto upper 1/3 of thigh 85%
4. Above knee upto lower 1/3 of thigh 80%
5. Through keen 75%
6. B.K. upto 8 cm 70%
7. B.K. upto lower 1/3 of leg 60%
8. Through ankle 55%
9. Syme's 50%
10. Upto mid-foot 40%
11. Upto fore-foot 30%
12. All toes 20%
13. Loss of first toe 10%
14. Loss of second toe 5%
15. Loss of third toe 4%
16. Loss of fourth toe 3%
17. Loss of fifth toe 2%

6. Guidelines for Evaluation of Permanent Physical Impairment of Congenital

deficiencies of the limbs
6.1 TRANSVERSE DEFICIENCIES
1. Functionally congenital transverse limb deficiencies are comparable to acquired amputations

and can be called synonymously as congenital amputation, however, in some cases revision of
amputation is required to fit in a prosthesis.
2. The transverse limb deficiencies therefore should be assessed on basis of the guidelines
applicable to the evaluation of PPI in cases of amputees as given in the
preceding chapter.
For example: PPI

Transverse deficiency Rt. Arm complete
90%
(shoulder disarticulation)
Transverse deficiency at thigh complete
90%
(hip disarticulation)
Transverse deficiency Proximal Upper arm
85%
(Above elbow Amp.)
Transverse deficiency at lower thigh
80%
(Above knee Amp. Lower 1/3)
Transverse deficiency forearm complete
75%
(elbow disarticulation)
Transverse deficiency lower forearm
65%
(Below Elbow Amp.)
Transverse deficiency carpal complete
60%
(wrist disarticulation)
Transverse deficiency Metacarpal complete
55%
(Disarticulation through carpal bones)
6.2 LONGITUDINAL DEFICIENCIES
6.2.1 Basic Guidelines
1. In cases of longitudinal deficiencies of limbs due consideration should be given to functional

impairment
2. In upper limb, loss of ROM loss muscular strength and hand functions like prehension, etc
should be tested while assessing the case for PPI
3. In lower limb clinical method of stability component and shortening of lower limb should be
given due weightage.

4. Apart from functional assessment the lost joint/part of body should also be valued as per
distribution Given in chapter Guidelines for Evaluation of PPI in upper extremity and lower
extremity The values so obtained should be added with the help of combing formula
Example:
Congenital Absence of humorous where forearm bones directly articulate with scapula. There
will be miled reduction in ROM and strength of muscles in the existing joints apart from loss of
body part.
Loss of shoulder joint can be given - 30%
Loss of ROM of Elbow/Shoulder & Wrist
All the components should be added together by the combining formula of a + b (90-a)/ 90
6.2.2 In cases of loss of single bone in forearm the evaluation should be based on the principles
of evaluation of Arm component which include Evaluation of ROM, Muscle strength-and
coordinated activities. The values so obtained should be added together with the help of
combining formula.
6.2.3 In cases of loss of single bone in leg the evaluation should be based on the principles of
evaluation of mobility component and stability components of the lower extremity. The values
obtained should be added together with the help of combining formula.

7. Guidelines for Evaluation of Physical Impairments in Neurological conditions.
7.1 Basic Guidelines:
1. Assessment in neurological conditions is not the assessment of disease but the assessment of
its effects, i.e. clinical manifestations.
2. These guidelines should only be used for central and upper motor neurone lesions.
3. Proformas (form A & B) will be utilized for assessment of lower motor neurone lesions,
muscular disorders and other locomotor conditions.
4. Normally any neurological assessment for the purpose of certification has to be done six
months after the onset of disease however exact time period is to be decided by the Medical
Doctor who is evaluating the case and has to recommend the review of certificate as given in
the standard format of certificate.
5. Total percentage of physical impairment in any neurological condition should not exceed
100%
6. In mixed cases the highest score will be taken into consideration. The lower score will be
added telescopically to it by the help of combining formula a+b(90-a)/90
7. Additional rating of 4% will be given for dominant upper extremity.
8. Additional weightage up to 10% can be given for loss of sensation in each extremity but the
total physical impairment should not exceed 100%.
7.2 Table – I
Neurological Status Physical Impairment

Altered sensorium 100%
7.3 Table - II
Intellectual Impairment (to be assessed by Clinical Psychologist)
Degree of Mental Retardation IQ Range Intellectual Impairment

Border line 70-79 25%
Mild 50-69 50%
Moderate 35-49 75%
Serve 20-34 90%
Profound Less than 20 100%
7.4 Table – III
Speech defect Physical Impairment

Mild dysarthria Nil

Moderate dysarthria 25%

Severe dysarthria 50%
7.5 Table – IV
Type of Cranial Nerve Involvement Physical Impairment

Motor cranial nerve 20% for each nerve
Sensory cranial nerve 10% for each nerve
7.6 Table-V
Motor system Disability
Neurological Involvement Physical Impairment

Hemiparesis:-
- Mild 25%
- Moderate . 50%
- Severe 75%
7.7 Table-VI
Sensory System Disability
Extent of Sensory Deficit Physical Impairment

Anaesthesia Upto 10% for each limb
Hypoaesthesia Depending upon % of loss of sensation
Paraestheis Upto 30% depending upon loss of sensation
Hands/feet sensory loss Depending upon % of loss sensation
7.8 Table - VIII

Bladder disability due to neurogenic Involvement
Bladder Involvement Physical Impairment

Mild (Hesitancy/Frequency) 25%
Moderate (precipitancy) 50%
Severe(occasional but recurrent Incontinence) 75%
Very Severe (Retention/Total Incontinence) 100%

7.9 Table - VIII
Post Head Injury Fits and Epileptic Convulsions
Physical
Frequency/Severity of Convulsions
Impairment
Mild - occurrence of one convulsion Only Nil
Moderate 1-5 Convulsions/month on Adequate - Medication 25%
Severe 6-10 Convulsions/month on Adequate medication 50%
Very Severe more than 10 fits/months On adequate - Medication 75%
7.10 Table - IX
Ataxia (Sensory or Cerebellar)
Severity of Ataxia Physical Impairment

Mild (Detected on examination) 25%
Moderate 50%
Severe 75%
Very Severe 100%

8. Guidelines for Evaluation of Physical Impairment due to Cardiopulmonary Diseases
8.1 Basic Guidelines:-
1. Modified New York Heart Association subjective classification should be utilized to assess
the functional disability.
2. The assessing physician should be alert to the fact that patients who come for disability
claims are likely to exaggerate their symptoms. In case of any doubt patients should be referred
for detailed physiological evaluation.
3. Disability evaluation of cardiopulmonary patients should be done after full medical, surgical
and rehabilitative treatment available, because most of these diseases are potentially treatable.
4. Assessment of cardiopulmonary impairment should also be done in diseases which might

have associated cardiopulmonary problems, e.g., amputees, myopathies, etc.
5. For respiratory assessment, routine respiratory functions test should be done, however, in
cases of interstitial lung diseases, diffusion studies may be done.
6. In cases of Angina pectoris (chest pain) base line studies in resting ECG should be done.
When there is persistence of symptoms, exercise or stress test should be done.
8.2 The proposed classification with loss of function is as follows:-
A patient with cardiopulmonary disease who is asymptomatic (i.e. has no

Group 0:
Symptoms of breathlessness, palpitation, fatigue or chest pain).
A patient with cardiopulm onary disease who becomes symptomatic during his
Group 1: Ordinary physical activity but has mild restriction (25%) of his physical activities.
A patient with cardiopulm onary disease who becomes symptomatic during his
Group 2: Ordinary physical activity and has 25-50% restriction of his ordinary physical
activities.
A patient with cardiopulmonary disease who becomes symptomatic during less than
Group 3:
ordinary physical activity so that his ordinary physical activities are 50-75% restricted.
A patient with cardiopulm onary disease who is symptomatic even at rest or on

Group 4: Mildest exertion so that his ordinary physical activities are severely or completely
restricted (75-100%).
A patient with cardiopulmonary disease who gets intermittent symptoms at rest (i.e.
Group 5:
Patients with bronchial asthma, paroxysmal nocturnal dyspnoea, etc.)

E. MULTIPLE DISABILITIES
1. Definition of Multiple Disabilities:

1. Multiple disabilities means a combination of two or more disabilities as defined in clause (i)
of Section (2) of the Persons with Disabilities. (Equal Opportunities, Protection of Rights and
Full Participation) Act, 1'995, namely –
I. Locomotor disability including leprosy cured

II. Blindness/low vision
III. Speech and hearing impairment
IV. Mental retardation
V. Mental illness
2. Guidelines for Evaluation:-
In order to evaluate the multiple disability, the same guidelines shall be used as have been
developed by the respective sub-committees of various single disability, viz. Mental retardation,
Locomotor disability, visual disability, and speech and hearing disability and recommended in
the meeting held on 29.2.2000 under the Chairmanship of Dr. S.P. Agarwal, Director General
of Health Services, Government of India, with reference to Order No.16- 18/96-Nl.l, dated 28th
August, 1998 and communicated to Ministry of Social Justice & Empowerment, Government of
India, vide letter No.S-13020/4/98-MH, dated 16th March, 2000.
However, in order to arrive at the total percentage of multiple disability, the combining formula
a + b (90-a)/90 as given in the Manual for Doctors to Evaluate Permanent Physical Impairment,
Developed by Expert Group meeting on Disability Evaluation", shall be used, where "a" will be
the higher score and "b" Will be the lower score.
However, the maximum total percentage of multiple disabilities shall not exceed 100%.
For example, if the percentage of hearing disability is 30% and visual disability is 20%,
then by applying the combining formula given above, the total percentage of multiple disability
will be calculated as follows:-
30 + 20(90-30) = 43%
3. Procedure for Certification of Multiple Disabilities:-
The procedure will remain the same as has been developed by the respective sub-committees on
various single disabilities and finalized in a meeting under the Chairpersonship of Dr. S.P.
Agarwal held on 29.2.2000. The final disability certificate for multiple disability will be issued
by Disability Board which has given higher score of disability by combining the score of
different disabilities using the combining formula, i.e., a + b (90-a). In case, where two scores
of disability are equal, the final certificate of multiple disability will be issued by any one of
them as decided by Local authority.

Chapter 6: Incentives and Concessions for PWDs

a. Free education up to the age of 18 years
b. Special schools for imparting special education promote integration of disabled students in
normal schools and provide opportunities for vocational training to disabled children.
c. Reservation of posts for the disabled upto one percent each for those who have blindness,
impaired hearing or cerebral palsy for which posts will be identified by the Government every
three years. Vacancies not filled up can be carried forward to the next year.
d. All Government educational institutions and aided institutions shall reserve upto 3% seats.
For persons with disabilities. Vacancies are to be reserved in poverty alleviation schemes.
Incentives are also to be given to employers to ensure that 5% of workforce is composed of
disabled persons.
e. Disabled persons will also be entitled to preferential allotment of land at concessional rates
for housing and for rehabilitation purposes.

Travel Concession
A. By Rail
I Blind Person:
The blind person traveling alone or with an escort, on production of a certificate from
Government doctor or a registered medical practitioner, is eligible to get the concession as
below:
Element of concession
Sleeper Season Ticket

Second
Class First Class Class First Class Second Class
Class
%age
75 75 75 50 50
concession
The concession certificate may be issued by the Station Master on collection of the certificate
form and the copy of original certificate duly attested.

II Orthopedically Handicapped Person:
The Orthopedically Handicapped person traveling with an escort-

Second
Class
%age
75 75 75 50 50
concession
III Deaf & Dumb Person

Second
Class
%age
50 50 50 50 50
concession
IV Mentally Retarded Person:

Second
Class
%age
75 75 75 50 50
concession
B. By Air
I Blind Person
The Indian Airlines Corporation allows 50% concessional fare to Blind persons or single
journey or single fare for round trip journey on all domestic flights.
II Locomotor Disability
Locomotor Disabled persons (80% and above) are allowed following Concession in Indian
Airlines:
a. 50% of normal Economy Class INR Fare or Point to Point Fare, Full Inland Air Travel Tax
and Passenger Service Fee applicable.
b. 50% of INR fare applicable to foreigners resident in India for travel on Domestic Sectors.
Full Inland Air Travel Tax and Passenger Service Fee applicable

Conveyance Allowance
Central Government employees,
Rate of Transport Allowance per

Sr . No. Pay Scale of Employee
(In Rs.) month
A-1"/"A" Class Other Places
City
1. Employees drawing pay in the
scale of Pay of Rs.8000-13500 or
above 800 400
2. Employees drawing pay in the

scale of Rs.6500-6900 or above
but below the scale Of Rs.8000- 400 200
13500
3. Employees drawing pay below
the
100 75
scale or Rs.6500-6900
f. Income Tax Concessions

Relief for Handicapped
 Under 80 DD (Deductions in respect of medical treatment, etc., of handicapped persons)-

For assesses (resident in India, an individual of a Hindu Undivided family) deduction of a
sum of fifteen thousand rupees only(Rs.15,000/-).
 Under 80DDA (Deduction in respect of deposit made for maintenance of handicapped
dependent) –For assesses (resident in India), an amount not exceeding twenty thousand
rupees (Rs.20,000) paid or deposited by him in the previous year out of his income
chargeable to tax.
 Under 80DDB (Deduction in respect of medical treatment etc.,) – A deduction of a sum of
fifteen thousand rupees only (Rs.15, 000) is allowed in respect of that previous year in
which such expenditure was incurred.
 Under 80U (Deduction in respect of permanent disability (including blindness)- In
computing the total income of an individual, assesses (suffering from a permanent physical
disability or mental retardation as specified in rules) shall be allowed a deduction of a sum
of forty thousand rupees (Rs.40,000).
 88B (Rebate of Income tax in case of individuals of 65 years and above) : An assesse (who
is of the age of sixty five years or more and gross total income does not exceed one hundred
and twenty thousand rupees) entitled to a deduction from the amount of income tax on his
total income with which he is chargeable for any assessment year, of amount equal to 40%
of such income-tax.
 88B (Rebate of income tax in case of individuals of 65 years and above) : An assesse (who
is of the age of sixty five years or more entitled to deduction of an amount equal to hundred
per cent of such income tax or an amount of ten thousand rupees only (Rs.10,000),
whichever is less.

 eg. Reservation of Jobs & Other Facilities for Disabled Persons

 Reservations in Gr 'C' & 'D' Posts – 3% in jobs have been made in Gr.'C' & Gr.'D' posts The
category of handicapped persons benefited are the blind, the deaf and the O.H. persons.
Persons with disability will be given preference at the time of recruitment in the identified
Gr.'A' and 'B' posts.
 Identification of jobs: In order to implement these reservations, without loss of
productivity some posts are identified disability wise.
 Posting of handicap candidates: As per the decision of Government of India Gr.'C' &
Gr."D" posts recruited on regional basis and who are physically handicapped may be given
posting as far as possible near to their native place within the region subject to
administrative constants PH employees may be given preference in transfer case near to
their native place.
 Relaxation of ban order on recruitment to vacancies earmarked for PH persons : As
per the Government order regarding ban on filling up of non-operational vacant post will
not be applicable in case of reserve vacancies to be filled up for PH persons.
 Carry forward of vacant posts under reserve category : As per the Government order if
a reserve category of person is not available or the nature of vacancy in an office is such
that the given category of person cannot be employed then the post may be carried forward
for a period of 3 subsequent years.
 Appointment of VH persons as canner in Government Deptt. : As per the decision of
Government of India it has been instructed that recanning of chairs in Government offices
should be done by blind persons as far as possible when the volume of work require a full
time chair canner then a suitable post may be created in consultation with the Finance.
 Instruction to appointing authority for intimating vacancies reserved for handicap.
 Age Concession to PH persons: As per the Government order it has been decided to
extend the age concession of 10 years.
 Relaxations in typing qualifications
 Consideration for confirmation in job for blind person
 Reservation for PH persons in posts filled by promotion
 Exemptions from payment of examinations fee

APPENDIX I
APPENDIX.I OF ANNEXURE.A
FROM A
ASSESSMENT PERFORMA FOR UPPER EXTREMITY
Name ___________..Age _______.Sex _____.Diagnosis ______.
Address ____________ O.P.D ________ Deptt _________.
ARM COMPONENT (Total Value 90%)

Arm Component Normal Rt. Lt. Loss Loss Mean Sum
of
Component Value Side Side of of % Combinin %
(Degrees) % % Loss % g Value Summary
Rt. Lt. Rt. Loss
Value for
Rt. Rt. Lt.
Side Side Lt. component
Lt.
Range of 1. Flexion- 0-220o
Movement Extension Arc 0-180o
(Active) Value 2. Rotation Arc 0-180o
90% 3. Abduction -
Elbow Adduction Arc
Shoulder Range of
1. Flexion - 0-160o
Movement
Extension Arc 0-55o
(Active) Value
2. Radial –
90%
Ulnar deviatior
Wrist
Arc
1. Flexion
Muscle
2. Extension
Strength Value
3. Rotation -
90%
Ext
Shoulder
4. Rotation -
Int.
5. Abduction
6. Adduction
1. Flexion
Muscle
2. Extension
Strength Value
3. Pronation
90%
4. Supination
1. Dors Flexion
Muscle
2. Palmar
Strength Value
Flexion
90%
3. Radial
Deviation
4.
Ulnardeviatio

Coordinated 1. Lifting overhead objects remove and

Activities placing at the same place 9%
Value 90% 2. Touching nose with end of extremity 9%
3. Eating Indian Style 9%
4. Combing and Plaiting 9%
5. Putting on a shirt/kurta 9%
6. Ablution glass of water 9%
7. Drinking Glass of water 9%
8. Buttoning 9%
9 Tie Nara Dhoti 9%
10. Writing 9%
HAND COMPONENT (TOTAL VALUE 90%)
Movement
30% Normal
1. Index
prehension Value
2. Middle
1. Hand 2]
3. Ring
Component A. 2] 8%
4. Little
Opposition(8%) B. 2]
Key Holding
Lateral 2]
a. Large Object
Pinch 5%
( 4o)
(5%) 3}
b. Small Object
C. Cylindrical 3} 6%
(1o)
Grasp 3}
a. Large Object
D. Spherical 3} 6%
( 4o)
Grasp 5%
b. Small Object
E. Hook Grasp
(1o)
Lifting Bag
2. 1. Radial Side 4:1
Sensation 30% } (4.8 : 1.2)
2. Ulnar Side }
Thumb
3. Radial }
Fingers
4. Ulnar}
1. Grip 20%
3. Strength 30% Strength 10%
2. Pinch
Strength
Summary value for upper extremity is calculated from component and hand component values
Add 4% for dominant extremity 10%. Additional weightage to be given to infection, deformity,
malalignment, contracture, cosmetic appearance and abnormal mobility.

APPENDIX .I OF ANNEXURE . A
FORM B
ASSESSMENT PERFORMA FOR LOWER EXTREMITY
Name________. Age________ Sex _______..Diagnosis__________..
Address______________..O.P.D. No_________..Deptt_______.
Diagnosis______________________
MOBILITY COMPONENT (Total Value (90%)
Loss Loss % Summary

Joint Component Normal Rt. Lt. Mean Mean
of of Combing Value for
Value Side Side % % 0.30
% Value Rt. mobility
Rt. Rt.
Rt. Lt. Lt. Component
Lt. Lt.
Side Side a+b (90+a)/90
1. Flexion- 0-140°
Range of
Extension 0-90°
Movement
arc 0-90°
(Active)
2.
HIP
Abduction
Adduction
3. Rotation
arc
Range of
1. Flexion 0-125°
Movement
Extension
(Active)
are
KNEE
1. Dors0-70°
Range of
flexion 0-60°
Movement
Panterlexion
(Active)
are
ANKLE
2. Invesior -
&
Extension
FOOT
are
1. Flexor
HH Muscles
2. Extensor
Muscles
3. Abductor
Muscles
4. Adductor
Muscles
5. Rotator
Muscles

(Ext. Int.)
1. Flexor
Muscles
Muscles
Strength
2. Extensor
KNEE
Muscles
Muscle 1.
Strength Panterliexor
ANKLE Muscles
& 2.
FOOT Darsiflexor
Muscles
3. Invertor
Muscles
4. Exertor
Muscles
STABILITY COMPONENT (Total Value 90%)
Based CLINICAL METHOD of Evaluation
1. Walking on plain surface 10

2. Walking on slope 10
3. Climbing Stairs 10
4. Standing on both legs 10
5. Standing on affected leg 10
6. Squatting on floor 10
7. Sitting Cross leg 10
8. Kneeling 10
9. Taking turns 10
Total 90
10% is given for complications like (i) Infection (ii) Deformity (iii) Loss of sensation.

APPENDIX II
Appendix II. Annexure ‘B’
Ready Reckoner Table for A + B (90-A)/90
B(1 B(2) B(3) B(4) B(5) B(6) B(7) B(8) B(9) B(10 B(11 B(12 B(13 B(14 B(15
A(1) 1.9 3.98 3.97 4.96 5.94 6.93 7.92 8.91 9.90 10.8 11.8 12.8 13.8 14.8 15.8
A(2) 2.9 3.96 4.93 5.91 6.89 7.87 8.84 9.82 10.8 11.7 12.7 13.7 14.7 15.6 16.6
A(3) 3.9 4.93 5.90 6.87 7.83 8.80 9.77 10.7 11.7 12.6 13.6 14.6 15.5 16.5 16.6
A(4) 4.9 5.91 6.87 7.82 8.78 9.73 10.6 11.6 12.6 13.5 14.4 15.3 16.3 17.2 18.3
A(5) 5.9 6.89 7.83 8.78 9.72 10.6 11.6 12.5 13.5 14.4 15.3 16.3 17.2 18.2 19.1
A(6) 6.9 7.87 8.80 9.73 10.6 11.6 12.5 13.4 14.3 15.3 16.2 17.2 18.1 19.0 20.0
A(7) 7.9 8.84 9.77 10.6 11.6 12.5 13.4 14.3 15.2 16.2 17.1 18.0 18.9 19.9 20.8
A(8) 8.9 9.82 10.7 11.6 12.5 13.4 14.3 15.2 16.2 17.1 18.0 18.9 19.8 20.7 21.6
A(9) 9.9 10.8 11.7 12.6 13.5 14.4 15.3 16.2 17.1 18.0 18.9 19.8 20.7 21.6 22.5
A(10 10. 11.8 12.6 13.5 14.4 15.3 16.2 17.1 18.0 18.8 19.7 20.6 21.5 22.4 23.3
A(11 11. 12.7 13.6 14.5 15.3 16.2 17.1 18.0 18.9 19.7 20.6 21.5 22.4 23.2 24.1
A(12 12. 13.7 14.6 15.4 16.3 17.2 18.0 18.9 19.8 20.6 21.5 22.4 23.2 24.1 25.0
A(13 13. 14.7 15.5 16.4 17.2 18.1 18.9 19.8 20.7 21.5 22.4 23.2 24.1 24.9 25.8
A(14 14. 15.6 16.5 17.3 18.2 19.0 19.9 20.7 21.6 22.4 23.2 24.1 24.9 25.8 26.6
A(15 15. 16.6 17.5 18.3 19.1 20.0 20.8 21.6 22.5 23.3 24.1 25.0 25.8 26.6 27.5
A(16 16. 17.6 18.4 19.2 20.1 20.9 21.7 22.5 23.4 24.2 25.0 25.8 26.6 27.5 28.3
A(17 17. 18.6 19.3 20.2 21.0 21.8 22.6 23.4 24.3 25.1 25.9 26.7 27.5 28.3 29.1
A(18 18. 19.6 22.3 21.2 22.0 22.8 23.6 24.4 25.2 26.0 26.8 27.6 28.4 29.2 30.0
A(19 19. 20.5 23.3 22.1 22.9 23.7 24.5 25.3 26.1 26.8 27.6 28.4 29.2 30.0 30.8
A(20 20. 21.5 24.2 23.1 23.8 24.6 25.4 26.2 27.0 27.7 28.5 29.3 30.1 30.8 31.6
A(21 21. 22.5 25.2 24.0 24.8 25.6 26.3 27.1 27.9 28.6 29.4 30.2 30.9 31.7 32.5
A(22 22. 23.5 26.2 25.0 25.7 26.3 27.2 28.0 28.8 29.5 30.3 31.0 31.8 32.5 33.3
A(23 23. 24.4 27.1 25.0 26.7 27.4 28.2 28.9 29.7 30.4 31.1 31.9 32.6 33.4 34.1
A(24 24. 25.4 28.1 26.9 27.6 28.4 29.1 29.8 30.6 31.3 32.0 32.8 33.5 34.2 35.0
A(25 25. 26.4 29.1 27.8 28.6 29.3 30.0 30.7 31.5 32.2 32.9 33.6 34.3 35.1 35.8
A(26 26. 27.4 30.0 28.8 29.5 30.2 30.9 31.6 32.4 33.1 33.8 34.5 35.2 35.9 36.6
A(27 27. 28.4 31.0 29.8 30.5 31.2 31.9 32.6 33.3 34.0 34.4 25.4 36.1 36.8 37.5
A(28 28. 29.3 32.0 30.7 31.4 32.1 32.8 33.5 34.4 34.8 35.5 36.2 36.9 37.6 38.3
A(29 29. 30.3 32.9 31.7 32.3 33.0 33.7 24.4 35.1 35.7 36.4 37.1 37.8 38.4 39.1
A(30 30. 31.3 32.0 32.6 33.3 34.6 35.3 36.0 36.6 36.6 37.3 38.0 38.6 39.3 40.0

A(31) 31. 32.3 34.9 33.6 34.2 34.9 35.5 36.2 36.9 37.9 38.2 38.8 39.5 40.1 40.8
A(32) 32. 33.2 33.9 34.5 35.2 35.8 36.5 37.1 37.8 38.4 39.0 39.7 40.3 11.0 11.6
A(33) 33. 34.2 34.9 35.5 36.1 36.8 37.4 38.0 38.7 39.3 39.9 40.6 41.2 41.8 42.5
A(34) 34. 35.2 35.8 36.4 37.1 37.7 38.3 38.9 39.6 40.2 40.8 41.4 42.0 42.7 43.3
A(35) 35. 36.2 36.8 37.4 38.0 38.6 39.2 39.8 40.5 41.1 41.7 42.3 42.9 43.5 44.1
A(36) 36. 37.2 37.8 38.4 39.0 39.6 40.2 40.8 41.4 42.0 42.6 43.2 43.8 44.4 45.0
A(37) 37. 38.1 38.7 39.3 39.9 40.5 41.1 41.7 42.3 42.8 43.4 44.0 44.6 45.2 45.8
A(38) 38. 39.1 39.7 40.3 40.8 41.4 42.0 42.6 43.2 43.7 44.3 44.9 45.5 46.0 46.6
A(39) 39. 4013 40.7 41.2 41.8 42.4 42.9 43.5 44.1 44.6 45.2 44.8 46.3 46.9 47.5
A(40) 40. 41.1 41.6 42.2 42.7 43.3 43.8 44.4 45.0 45.5 46.1 46.6 47.2 47.7 48.3
A(41) 40. 40.0 42.6 43.1 43.7 44.2 44.8 45.3 45.9 46.4 46.9 47.5 48.0 48.6 49.1
A(42) 42. 43.0 43.6 44.1 44.6 45.2 45.7 46.2 46.8 47.3 47.8 48.4 48.9 49.4 50.0
A(43) 43. 44.0 44.5 45.0 45.6 46.1 46.6 47.1 47.7 48.2 48.7 49.2 49.7 50.1 50.8
A(44) 44. 45.0 44.5 46.0 46.5 47.0 47.5 48.0 48.6 49.1 49.6 50.1 50.6 51.6 51.6
A(45) 45. 46.0 46.5 47.0 47.5 48.0 48.5 49.0 49.5 50.0 50.5 51.0 51.5 52.0 52.5
A(46) 46. 46.9 47.4 47.9 48.4 48.9 49.4 49.9 50.4 50.8 51.3 51.8 52.3 52.8 53.3
A(47) 47. 47.9 48.4 48.9 49.3 49.8 50.3 50.8 51.3 51.7 52.2 52.7 53.2 53.6 54.1
A(48) 48. 48.9 49.4 49.8 50.3 50.8 51.2 51.7 52.2 52.6 53.1 53.6 54.0 54.5 55.0
A(49) 49. 49.9 50.3 50.8 51.2 51.7 52.1 52.6 53.1 53.5 54.0 54.4 54.9 55.3 55.8
A(50) 50. 50.8 51.3 51.7 52.2 52.6 53.1 53.5 54.0 54.4 54.8 55.3 55.7 56.2 56.6
A(51) 51. 51.8 52.3 52.7 53.1 53.6 54.0 54.4 54.9 55.3 55.7 56.2 56.6 57.0 57.5
A(52) 52. 52.8 53.2 53.6 54.1 54.5 54.9 55.3 55.8 56.2 56.6 57.0 57.4 57.9 58.3
A(53) 53. 53.8 54.2 54.6 55.0 55.4 55.8 56.2 56.7 57.1 57.5 57.9 58.3 58.7 59.1
A(54) 54. 54.8 55.2 55.6 56.0 56.4 56.8 57.2 57.6 58.0 58.4 58.8 59.2 59.6 60.0
A(55) 55. 55.7 56.1 56.5 56.9 57.3 57.7 58.1 58.5 58.8 59.2 59.6 60.0 60.4 60.8
A(56) 56. 56.7 57.1 57.5 57.8 58.2 58.6 59.0 59.4 59.7 60.1 60.5 60.9 61.2 61.6
A(57) 57. 57.7 58.1 58.4 58.8 59.2 59.5 59.9 60.3 60.6 61.0 61.4 61.7 62.1 62.5
A(58) 58. 58.7 59.0 59.4 59.7 60.1 60.4 60.8 61.2 61.5 61.9 62.2 62.6 62.9 63.3
A(59) 59. 59.6 60.0 60.3 60.7 61.0 61.4 61.7 62.1 62.4 62.7 63.1 63.4 63.8 64.1
A(60) 60. 60.6 61.0 61.3 61.6 62.0 62.3 62.6 63.0 63.0 63.6 64.0 64.3 64.6 65.0
A(61) 61. 61.6 61.9 62.2 62.6 62.9 63.2 63.5 63.9 64.2 64.5 64.8 65.1 65.5 65.8
A(62) 62. 62.6 62.9 63.2 63.5 63.8 64.1 64.4 64.8 65.1 65.4 65.7 66.0 66.3 66.6
A(63) 63. 63.6 63.9 64.2 64.5 64.8 65.1 65.4 65.7 66.0 66.3 66.6 66.9 67.2 67.5
A(64) 64. 64.5 64.8 65.1 65.4 65.7 66.0 66.3 66.6 66.8 69.1 67.4 67.7 68.0 68.3
A(65) 65. 65.5 65.8 66.1 66.3 66.6 66.9 67.2 67.5 67.7 68.0 68.3 68.6 68.8 69.1

A(66) 66.27 66.53 66.80 67.07 67.33 67.60 67.87 68.13 68.40 68.67 68.93 69.20 69.47 69.73 70.00
A(67) 67.26 67.51 67.77 68.02 68.28 68.53 68.79 69.04 69.30 69.56 69.81 70.07 70.32 70.58 70.83
A(68) 68.24 68.49 68.73 68.98 69.22 69.47 69.71 69.96 70.20 70.14 70.69 71.93 71.18 71.42 71.67
A(69) 69.23 69.47 69.70 69.93 70.17 70.40 70.63 70.87 71.10 71.33 71.57 71.80 72.03 72.27 72.50
A(70) 70.22 70.44 70.67 70.89 71.11 71.33 71.56 71.78 72.00 72.22 72.44 72.67 72.89 73.11 73.33
A(71) 71.21 71.42 71.63 71.84 72.06 72.27 72.48 72.69 72.90 73.11 73.32 73.53 73.74 73.96 74.17
A(72) 72.20 72.40 72.60 72.80 73.00 73.20 73.40 73.60 73.80 74.00 74.20 74.40 74.60 74.80 75.00
A(73) 73.19 73.38 73.57 73.76 73.94 74.13 74.32 74.51 74.70 74.89 75.08 75.27 75.46 75.64 75.83
A(74) 74.18 74.36 74.53 74.71 74.89 75.07 75.24 75.42 75.60 75.78 75.96 76.13 76.31 76.49 76.67
A(75) 75.17 75.33 75.50 75.67 75.83 76.00 76.17 76.33 76.50 76.67 76.83 77.00 77.17 77.33 77.50
A(76) 76.16 76.31 76.47 76.62 76.78 76.93 77.09 77.24 77.40 77.56 77.71 77.87 78.02 78.18 78.33
A(77) 77.14 77.29 77.43 77.58 77.72 77.87 78.01 78.16 78.30 78.44 78.59 78.73 78.88 79.02 79.17
A(78) 78.13 78.27 78.40 78.53 78.67 78.80 78.93 79.07 79.20 79.33 79.47 79.60 79.73 79.87 80.00
A(79) 79.12 79.24 79.37 79.49 79.61 79.73 79.86 79.98 80.10 80.22 80.34 80.47 80.59 80.71 80.83
A(80) 80.11 80.22 80.33 80.44 80.56 80.67 80.78 80.89 81.00 81.11 81.22 81.33 81.44 81.56 81.67
A(81) 81.10 81.20 81.30 81.40 81.50 81.60 81.70 81.80 81.90 82.00 82.10 82.20 82.30 82.40 82.50
A(82) 82.09 82.18 82.27 82.36 82.44 82.53 82.62 82.71 82.80 82.89 82.98 83.07 83.16 83.24 83.33
A(83) 83.08 83.16 83.23 83.31 83.39 83.47 83.54 83.62 83.70 83.78 83.86 83.93 84.01 84.09 84.17
A(84) 84.07 84.13 84.20 84.27 84.33 84.40 84.47 84.53 84.60 84.67 84.73 84.80 84.87 84.93 85.00
A(85) 85.06 85.11 85.17 85.22 85.28 85.33 85.39 85.44 85.50 85.56 85.61 85.67 85.72 85.78 85.83
A(86) 86.04 86.09 86.13 86.18 86.22 86.27 86.31 86.36 86.40 86.44 86.49 86.53 86.58 86.62 86.67
A(87) 87.03 87.07 87.10 87.13 87.17 87.20 87.23 87.27 87.30 87.33 87.37 87.40 87.43 87.47 87.50
A(88) 88.02 88.04 88.07 88.09 88.11 88.13 88.16 88.18 88.20 88.22 88.24 88.27 88.29 88.13 88.33
A(89) 89.01 89.02 89.03 89.04 89.06 89.07 89.08 89.09 89.10 89.11 89.12 89.13 89.14 89.16 89.17
A(90) 90.00 90.00 90.00 90.00 90.00 90.00 90.00 90.00 90.00 90.00 90 90.00 90.00 90.00 90.00

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'i '!ltt(i\& ~a!);!l \Cii\/~l~S ~l~<JQ ~~ell ~\fiat&/~~&\~ $\~l(-\.oll ~'t{\at& bl~ 'll'ol~(-1. ~t(-4-.U. 1;iWI. ~t<·U
rtc,{lc,{l ~~8t~.n '!kl *~ !l~t-1. ~i\. rl\ "'f '!ltllll.\l~ J.l.l""-1. :l\1<\lil..
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a~t~.tJ.~.i ~ua. 0.
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(~) <"l.l~rl;!oll \ll~'IU~ ~~~:»ctt.l ~it:>J.l~-~
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(3) G\l~ ~~t4 C~l 1ti ~~au ~'II'CJt..j 'd.l-l.tli!l\l'l il.SI.rsc-t ~mftil~ "'i\ l.lltt5rl.nt-l.l '!J.I.l121.J.~.l mfa.llll,.,l ~~&t~..n
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~ *ltll ltll\tt l{lt '!J.U.Ia\l'l ~~ !I~Clloi ~~t\ ~~ ctl-l.i ~tl§rtrlloi '!).1.\g\ \l\2\ f.tl\CI.ctloi ~~t\.
C'lrl 'In ll.fuc-t wm~ll.~ lii.~'II'Et~ ~tlktnt "Y-lttQI.\l?l. J.~.te c-ttll!l <>~. "1!12\lll rt\, bl~'ll'f.t~~ ;t llt~G~.t !lt~~aU..n
~li!l a~cu~ ~~il. ~~ \l.~!l-'4. J.~.i am!l R~rllll.~'ll'e.t<~ ~\>{tn ~12\ \l.Q\ !I(Cll..Q ~~i\.
Nl ~<-u.u. ~a ~S\&c-t ~~~< li\cuu-tt l.ll..zt il.S\ac-t t.Umftll.bl. e~ rs~c-t lll.tt&rtrll '!J.I.l121.\l~..O. o~.ac--t
~-c-u..u. :t{l• ll.S\sc-\ ~~M<~ \lli!l ~~W.~tu ll\!1<:-lt~.t..O. ~a.i\.
PRT(l)Notc& Tharaw
3
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~~ua ril. acu Mt~ ~ ~~tt~ ~cG.~ ~rast~ ~){at ~ctt tw.Jt~..n ~l{latt ){ti ~c(l:»91. ~~~ a~ ttai\. t~UcG.
~~\) ·~lfl i.(l tUi\ ~\fiCo\ .Ul~Ci .iltt rt 'J.){lQl'4.'l ~ '4.'l..{l ort&C-t 'i\sc{l. '4.Sit. ~l(lllll ~~~..{\ ~~~ lU,!tUl itc(l:»o~.
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~~"» J.t<rtn-<l cd\'llltll. \'4. ~elM~ S~c:tl.U dil. ~l~ Srti ~!i J.l.l~ !i~cU 'Cl"! <a.c-i.Co\ 40\ tUtl (\ ~(\ Rstc-1. 8~Cll.U
~~il 'i\ i\u ~tlirtrti.C:Ua£l at!Srt ~on~ ~ ltEfi~.n ~tt & c.n~ &\e ~ttsftrttafi ~strll i\tt ~0\ bt~~ a~cu ~*~
-t iltt cill~ C\.u attt~M~.U c:ttc.{t ~~"» &~ tt&il
(\) th i\~&c-t ~ellM uurt ~tl5rtrtt 'J.){tl!'4.~ '4.~ ~~ !i~c:tta{\ Knt ~mc:trtl ~m.at~"'-l CJ!.tlt ~0\ -t).j,ortt-vll
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&la
~cutt.{l ~~ ~\CU 'J.J.UI!\l'l '4.~ ~~ sit tt&t\ 41\~ ~C<·U &eu~ 'l"Wl ~C<-tl bll~Ol.l. blia&t~..fi .9tt~l.{l
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ittt rt~l! st2lcu4\ ncu..n ~~it
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s~O\ bttlirtnt-tt ~l\.U~ a~stil .Us~~l totott~rt "li'Jttt~ '4.~ R~Qj_s ctw.rt R~~s ~htt£\l!it~~ bltctl bltl5rlrtt
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lll!c-tcu.U ~~i\.
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SlltCll~ b~CU..O. ~~it. ~ 6~lct..0. ~til. (;\ttrt 8~Ci JjY~lrtl·~51"!> \l.?lM btl ~til. ~til.C-t. t) ~ tot~"li'El~~ 'li\~dl
OO.lU~ ~\lCUoj ~~t\.
'IVI
(1, '< Jl;...-
/Y) / r '
(blltl. :i;t, ~~l)
~~sn ~me{,
t~~.t~Ol.l. t.t~ \l.~ctl~ .&C-t~.ll?l <a.ouot.
'!~.
1. ~~e>c{~\U.Ci~G\1 ~ctlJUN::t l:.l:U~l)
z. ~. ~wtl\,(\~g\1 ~~j Wlct~.
3. ~c,l,l{,(\IJ(\/loli.CI\.~lWball.U. J{?(l~/~l.GI.ltl<>l ).{,(\~ol.l ~Jlrt ~~Cl~.
4. ~:>J.~~ct~. ~lU~a ~~ ~01. ~Cttst~rtl Ctl.ett:>t.~ro.cttc-t~. otlU\.e~~.:>t~.
S. !~tl~IJl\. ~a:>u rtc,{\c.(\ ictl~. rtr,{\{l{l ri\at~crl't S~~. ~. \:>Cl~le>c{ ~~rll etCI.ot, :>LiUlG~.:>L;!.
PRT (1 )Note & Tharaw

4
•
6. ~ta& Rltllol.&.,O,, rt<A\<1(\ ~Q.l~/"lSS.~~ ~l~~tri.<Al.CJ{t rile~.~ ~~ ~tl\Uot, =>ti\:.{\ot:>R
1. .a~wcrtc-t. ~U:~il stu~~e~. ::~tl\:.{\ot=>tv~'J..I.Etc:tte.tctS'le.<tnt"'l'~et\ll.tctot:>t~.
s. ~cr aG\aa~.,O.~.
9. ~cr ~c<-u lasHt ~last~&~.~.
10. £C\rsc-ti~l cul?,.n~ l-lt~ou !ilittt~l}(\.o{\ ~~~. 5\."l)ct~t'"o' l.l.~ru (.)lctCI\, :>tlUlot:>R
11. ~C( Fit:<-t.tcrl.l );t'W.l ~<-tt r~,CI{\,CJ{\. ~t\l!!t~&l.~.~~!sl~ ~ec-t~~tt ~~e'.!s&I.W rl.tll ~llj~!s ~l~~ ~~atl
~~~ «~ ~lWCI\l 'Y.ltt~& ~l~~ ~~ (!lflt!l~&\.(~L) neAl~ ~cu ~;). rtCI{\<Jl\ ~et~ ~l~l)
12. ~cr LYc<-tl ~ta~ ~taat:fl4flbti.
13 . .u.® taoo.~t.~l- tlllltl, ~~cuc-tu, :>ti\.itat:>l~.
14. ~c:t.lC-lUCI\l uct ~QI.t:>l\,
15. l{t~rtl Rut'J..I.r,, :>tl\:.{\at=>t~.
16. c1.<A\<A\ S\G\.-a"otl S\.ot&\., ~l.l.f.lctlE /ctSlE.~l/~~rl/"1$\l.l.crl.=>lV<l"'I'MG/ /QI.lClcrl.:llV~oec-t Sl&."'l', ~lH.lctlE.,
17. CllClMll\l&l)(l, ~~!il~ 'l:l"alC-lU, :>tiUlat:>l~(6~lct..U ............... ot!;C.{t ~l~c:tlall [qai_c{t ~~)
1s. oo."ttt Rlttl-l!s, :>ti\:[l~~t:>t<.
19. ~l~ae "11'-t~C-l.~l.I.ElCllEI<l"'I'Mi!,
zo. ~~tflt ~0\ rrt"il:fl Rutltts, oti\:.{\cr~.:>t~.
21. \l ~crS ~&l~~ ~~~~. :>tiUlat:>lV~l.l.ElCllE.,
22. Rctt~ ~Be ~l.a!it~4fi. :>ti\:[lot:>tV~l{E.tctte.,
23. Clltll ~C<-ll lrti\~ ~£a&t~.
24. ~(i).c:t.~. :>j~lrt c1.'tsElfl. ~l~:>l, :>ti\.itat:>t<(\l-::( \:..Ctl<l)
25. ~tilct&\.; :>j"'l'<lrl "lSS.~< ilCl.l ~leU:>l.~l.I.E.lctlE(\t'l \:..Ctlil)
26. ~l~'JO.. :lj"ll';!lrll?l~&\.~. ~llElctlE(\t-::( \:..Ctl.<l)
27. ~c:t.,{l, :>jlljs'~lrl f.C\~lo1.~1Rl.~(ilctlC1U, =>ti't.{\.ot:ll~(~?t \A.l~l)
1 •• "'.
2s. ~a~~~ \l~ctt~ &c~t~ !.C\QttotcrO. ~cr tuwtbti/~ct :ut£a8t~&~.w

29. ~&!se ~~-~.
3o. oll.llC~t ~s'ttcr~. ~larst~ m.a.&a ~L~-t.
PRT (l)'Note & Tharaw 5

Form~l
APPLXCATION FOR OBTAINING DISABILITY CERTIFICATE BY PERSONS

WITH DISABILITIES
{See rule 3)
1. Name: (Surname)----- (Arst n a m e ) - - - - - (Middle name) - - - - - -
2. Father's name: ------Mother's name: - - - - - -
3. Date of Birth: (date) _ _ _ / (month)· _ _ _ / (year),_ __
4. Age at the time of application: _ _ _ years
5. Sex: Male/Female
6. Address:
(a} Permanent address (b) Current Address (I.e. for communication)
(c) Period since when residing at current address

.........
7. Educational Status (Pl. tick as applicable)
I. Post Graduate ·
IL Graduate
Ill. Diploma
IV. Higher Secondary
V. High School
VI. Middle
VII. Primary
VIII. Illiterate
8. Occupation----------------
9. Identification marks (i) _ _ _ _ (II) _ _ __
10. Nature of disability: locomotor/hearing/visual/mental/others
11. Period since when disabled: From Birth/Since _ _ _ _ _ year
12. (I) Old you ever apply for Issue of a disability certificate In the past. YES/NO
(II) If yes, d,et'llls:
(a) Authority to Whom and district In which applied - - - - - - - - - - - -
(b) Result of a p p l i c a t i o n - - - - - - - - - - - - - -
13. Have you ever been Issued a disability certificate In the past? If yes, please enclose a true copy.
PRT (})Note & Tharaw 16
r:
DetlaraUon; I hereby declare that all particulars s~a~ed above are true to the best of mv knowledge and
beller, and no material lnfonnatlon has been concealed'or misstated. I further, state that-If any inaccuracy is
detected In the application, I shall be liable to forfeiture of any benefits derived and other action as per law.
(Signature or left thumb impression of

person with disability, or of his/her legal
guardian In case of persons with mental
retardation, autism, cerebral palsy and
multiple disabilities)
.' .....
_,r:: . ·
End:
1. Proof of residence (Please tick as applicable)

a. ration card,
b. vorer Identity card,
c. dr1VIng license,
d. bank passbook
1
~""'='z e. PAN card,
;:::¥~ t. passport,
g. telephone, electrtdty, water and any other utility bill Indicating the address of the applicant,
h. a certificate of residence Issued by a Pi!ll"'chayat, municipality, cantonment board, any
gazetted officer, or the concerned Patwari or Head Master of a Govt. school,
1. in case of an Inmate of a resldentlallnstltutlon for persons with disabilities, destitute,
mentally Ill, etc., a certificate of residence from the head of such Institution.
2. Two recent passport size photographs
(For office use only)
Date: Signature of Issuing authority

Place: Stamp
....
I
PRT (I )Note & Tharaw

17
--------- ··- - - -----
Disability Certificate
(In cases of amputation or complete permanent paralysis of limbs
and in cases of blindness)
(See rule 4)
(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE

CERTIFICATE)
Recent PP size
Attested
Photograph
(Showing face
only) of the person
with disabUlty
Certificate No. Date:
This Is to certify that I have carefully examined Shri/Smt./Kum.

son/wife/daughter of Shrl bate of Birth (DD I MM I YY) _ _ __
Age years, male/female Registration No. permanent resident of House
No. Ward/VIllage/Street Post Office District._ _ __
State._ _ _ _ _ _-/ whose photograph Is affixed above, and am satisfied that :
(A) he/she Is a case of:
* locomotor disability
* blindness
(Please tick as applicable)

(B) the diagnosis In his/her case is - - - - -
(A) He/ She has %(In figure) percent (in words)
pennanent physical Impairment/blindness In relation to his/her_ _ _ _(.part of body) as per
guidelines (to be specified).
2. The applicant has submitted the following document as proof of residence:-
Nature of Docume1nt Date of Issue Details of authority Issuing certificate
(Signature and Seal of Authorised Signatory of

notified Medical Authority)
Signature /Thumb Impression

of the Person In whose favour
disability certificate Ia .Issued.
PRT {I )Note & Tbaraw
18
Form-III
Disability Certificate
(In case of multiple disabilities)
CERTIFICATE)
(See rule 4)
Recent PP size
Attested
Photograph
(Showing face
only) of the persOn
with disability
This Is to certify that we have carefully examined Shri/Smt./Kum . _ _ _ _ _ _ _ __

/son/wife/daughter- of Shrl Date of Birth {00/MM!YY) _ _ _
._. Age years, male/female, Registration No. permanent resident of
House No. Ward/Village/Street Post Office._ _ _ __
District State , whose photograph is affixed above, and are satisfied
that:
(A) He/she Is a Case of Multiple Disability. His/her extent of permanent physical

Impairment/disability has been evaluated as per guidelines (to be specified) for the
dtsablllties ticked below, and shown against the relevant disability in the table below:
s. .Dlsabmty Affected Part of

Diagnosis
Permanent physical Impairment/
No. Body mental disability (In Ofo)
1 Locomotor disability @
2 Low vision #
3 Blindness Both Eyes
4 Hearing lmpalnnent £
5 Mental retardation X
6 Mental-Illness X
(B) In the light of the above, his /her over all permanent physical impairment as per
guidellnes(to be specified), Is as follows:-
In figures:- _ _ _ _ _ _ _ _ percent
In words:-_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ percent
PRT (1 )Note & Tharaw

19.
~ .: -
. ....
2. This condition Is progressive/ non-progressive/likely to improve/ not likely to improve.
3. Reassessment of disability Is:
(I) not necessary,
Or
(II) Is recommended/ after years months, and therefore this

certificate shall be valid till (DO I MM 1 YY) _ _ _ _ __
0 ·e.g, Left/Right/both arms/legs
# • e.g. Single eye/both eyes

'·
~-~
£ - e.g, Left/Right/both ears
Details of authority Issuing

Nature of Document Date of Issue.
certlflcate
5. Signature and seal of the Medical Authority.
Name and seal of Member Name and seal of Member Name and seal of the
Chairperson
Signature /Thumb impression

of the Pt~rson In whose favour
~,.•:'~,: disability certtflcate Is Issued.
·' ..
PRT (t)Notc & Tharaw

20
.
...
Eorm·IV
Dlsab311ty Certificate
(In c:aes other than those mentioned In Forms II and III)

CER11FICATE}
(See rule 4)
Recent PP size
Attested
Photograph
(Showing face
only) of the person
with dsabillty
.... -~
This Is to certify that I have carefully examined Shri/Smt./Kum. _ _ _ _ _ _ _ _ __

son/wife/daughter of Shri_ _ _ _ _ _ _ _ Date of Birth (DD/MM/YY) _ -._ __
Age._ _ _years, male/female, Registration No·-~-- permanent resident of House
No •. ____ WardNIIIage/Street._ _ _ _ _ _ Post Office _ _ _ _ District _ _ __
State_ _ _ _ _ _, whose photograph is affixed above, and am satisfied that he/she is
a case of_ _ _ _ _ _ _ _ _ _ _ disability. His/her extent of percentage physical
impairment/disability has been evaluated as per guidelines (to be specified) and Is shown
against the relevant disability In the table below:
s. Disability Affected Part of

Diagnosis
Permanent physical Impairment/
No. Body mental disability (In%)
1 Locomotor disability @
2 Low vision #
3 Blindness Both Eyes
4 Hear1ng Impairment £
5 Mental retardation X
6 Mental-Illness X
(Please strike out the disabilities which are not applicable.)
· 2. The above condition Is progressive/ non-progressive/ likely to Improve/ not likely to

. improve.
PRT (I }Note &. Tharaw

21
3. Reassessment of disability Is :
{I) not necessary,
Or
(II} Is recommended/ after years months, and therefore this certificate

shall be valid till (DO I MM I YY)_·_ _ - · -
0 - e.g. Left/Right/both arms/legs
# - e.g. Single aye/both eyes
£ - e.g. Left/Right/both ears
Details of authority Issuing

Nature of Document Date of Issue certlfteate
(Authorised Signatory of notified Medical Authority)

·(Name and Seal)
Countersigned
{Countersignature and seal or the

CMO/Medlcal Superintendent/Head of
Govemment Hospital, In case the
certificate Is Issued by a medical
authority who Is not a government
servant (with seal)}
~e/Th\lnb
lniPfesslon of ~
·pEI'Sm ln wtllSe
·favotr dlsabmty
certtftarte Is
Issued.
Note:. In case this ceitlftcate Is Issued by a medical authority who is not a government
servant, It shall be valid only tf cou_nterslgned by the Chief Medical Officer of the District. •
PRT(l)Note&.Tharaw
22
cjib1
Form-V
Intimation of Rejection of Application for Disability Certifecate
(See rule- 4)
No ............................ . Dated: ....................... .
To,
(Name and address of applicant
For Disabil.\ty Certificate)
Sub :- Rejection of Application for Disability Certificate
Sir/Medam,
Please refer to your application dated ................. for issue of a Disability Certificate
for the following disability :
2. Pursuant to the above application, you have been examined bythe undersigned/Medical
Board on · and 1 regret thet. for the reasons mentioned below, it is not possible to
issue a disability certificate in your favour :
(i)
(ii)
(iii)
3. In case you are aggrived by the rejection of your application, you may represent to
- - - - - - - - - - - - - - ' r e q u e s t i n g for review of this dicision.
Yours faithfully,
(Authorised Signatary of the notified Medical Authority)

(Name and seal)
[F. N. 16-0212007-DD. 111)

......... Dr.ARBIND PRASAD, Jt. Secy .
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Ability Gujarat - Administrative User Manual

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Ability Gujarat - Administrative User Manual

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“Ability Gujarat”

Disability User Manual www.ability.gujarat.gov.in Page 1

Disability User Manual www.ability.gujarat.gov.in Page 2

Chapter 1: What is Ability Gujarat Project

Features of Ability Gujarat:

• Scientific assessment of degree of the disability based on guidelines and formulae.

Disability User Manual www.ability.gujarat.gov.in Page 3

• Direct online registration from website ( www.abilitygujarat.in )

• PwD can visit nearby Public Health Facility for assessment

• If degree of disability is more than 40% - certificate will be issued

Features of Ability Gujarat:

• Generation of a computer based Disability Certificate with unique ID along with

Benefits of the Ability Gujarat:

Chapter 2: Major Recommendations to simplify the Process

Chapter 3: Old Model v/s New Model

Before Recommendation After Recommendation

Disability User Manual www.ability.gujarat.gov.in Page 5

Chapter 4: Disability Certification Process

S.No Type of Health Care Facility to Authorized person to Appellate Body

Disability User Manual www.ability.gujarat.gov.in Page 6

are available and also Hospital/Superintendent

Disability User Manual www.ability.gujarat.gov.in Page 7

Chapter 5: (I) Guidelines for Evaluation of Various

1. Definition - Mental retardation is a condition of arrested or incomplete development of the

2. Categories of Mental Retardation

I. total absence of sight; or

Disability User Manual www.ability.gujarat.gov.in Page 8

i. Reduction of fields less than 50 degrees

3. Categories of Visual Disability

Note: F.C. means finger count

C. SPEECH & HEARING DISABILITY

1. Definition of Hearing: - A persons with hearing impairment having difficulty of various

2. Categories of Hearing Impairment

Type of Speech % age of

Disability User Manual www.ability.gujarat.gov.in Page 9

iv. Locomotor Disability: Locomotor disability is defined as a person’s inability to execute

II. REVISED GUIDELINES FOR EVALUATION OF THE PERMANENT PHYSICAL

1. Guidelines for Evaluation of Permanent Physical Impairment of Upper Limb

5. Measurement of loss of function of hand component consists of determining the prehension,

Disability User Manual www.ability.gujarat.gov.in Page 10

1.2 ARM COMPONENT

Total value of arm component is 90%

1.2.1 Principles of evaluation of range of motion (ROM) of joints

Arc of ROM Normal value Active ROM Loss of ROM

1.2.2. Principles of evaluation of strength of muscles:

2. Loss of muscle power can be given percentages as follows:

Manual muscle Strength Lo ss of Strength in

Disability User Manual www.ability.gujarat.gov.in Page 11

1.2.3 Principles of evaluation of coordinated activities:

1. The total value for coordinated activities is 90%

Disability User Manual www.ability.gujarat.gov.in Page 12

1.3.2. Principles of Evaluation of sensation:

i. Complete loss of sensation

1.3.3. Principles of Evaluation of strength

1. Total value of strength is 30%.

ii. Pinch strength 10%

First 1" - No weightage

1.3.4. Combining values of hand component:

1.3.5. Combining values for the Extremity:

Disability User Manual www.ability.gujarat.gov.in Page 13

Impairment of Arm - 27% 64+27(90-64)/90

2. Guidelines for Evaluation of permanent physical Impairment in Lower Limb.

2.1 MOBILITY COMPONENT