|
New Patient
|
Return Patient
|
|
Chief Complaint
• • •
|
Present Medical
• • •
|
|
Chief Complaint Other
|
Medical Conditions Other
|
|
MVA
|
Pain Quality
• • •
|
|
Fibromyalgia
• • •
|
Pain Scale
|
|
Timing
• • •
|
Comments
|
|
Status
• • •
|
|
|
|
|
|
Right Hand and Wrist Exam
• • •
|
Left Hand and Wrist Exam
• • •
|
|
Right Elbow Exam
• • •
|
Left Elbow Exam
• • •
|
|
Right Shoulder Exam
• • •
|
Left Shoulder Exam
• • •
|
|
Right Hip Exam
• • •
|
Left Hip Exam
• • •
|
|
Right Pelvic Exam
• • •
|
Left Pelvic Exam
• • •
|
|
Right Knee Exam
• • •
|
Left Knee Exam
• • •
|
|
Right Ankle Exam
• • •
|
Left Ankle Exam
• • •
|
|
Right Foot Exam
• • •
|
Left Foot Exam
• • •
|
|
|
|
|
Postural Assessment
• • •
|
Short Leg
|
|
Reflexes
• • •
|
Pelvic Fixation
• • •
|
|
|
Spinal Facet Fixations
• • •
|
|
PRT Full Select
|
|
|
Cranium PRT
• • •
|
Wrist and Hand PRT
• • •
|
|
Cervical Anterior PRT
• • •
|
Anterior Lumbar Spine PRT
• • •
|
|
Posterior Cervical PRT
• • •
|
Posterior Lumbar PRT
• • •
|
|
Medial Back Ribs PRT
• • •
|
Sacrum Posterior PRT
• • •
|
|
Ribs Posterior PRT
• • •
|
Pelvis / Hip Anterior PRT
• • •
|
|
Thoracic Posterior PRT
• • •
|
Pelvis / Hip Posterior PRT
• • •
|
|
Thoracic Anterior PRT
• • •
|
Knee PRT
• • •
|
|
Shoulder PRT
• • •
|
Foot PRT
• • •
|
|
Elbow PRT
• • •
|
Ankle PRT
• • •
|
|
|
|
|
Neuroanatomical Acupuncture
|
Ligamentous Articular Strain
• • •
|
|
INMAS Supine
• • •
|
Strain Counterstrain
• • •
|
|
INMAS Prone
• • •
|
Myofascial Release
• • •
|
|
Laser Therapy
|
Motor Points [+]
• • •
|
|
|
Kinesio Tape
• • •
|
|
|
Pain Management ICD-9
• • •
|
|
|
Total Time Spent
• • •
|
|
|
Follow-up
|
