What was the cause of the fall: was the fall a result of an accident (misstep, tripping) or due to some impairment such as weakness, dizziness, poor coordination, confusion syncope, etc.?
(Please indicate all that apply).
2. Does the patient have any of the following medical History/Risk Factors for falls: Stroke,
Parkinson’s disease, Diabetes, Hypoglycemia, Seizure, Chronic corticosteroid use, Dizziness,
Arrhythmia, Alcohol abuse, Syncope, Other
3. Please confirm the location of the pelvic fracture and if this was a result of the fall
4. Please confirm what treatment the patient had for the pelvic fracture
5. Please provide the patient’s medical history and concomitant medications prior to the accident