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Subjective
Chief complaint
Area
Better than last visit?
From last to present visit notes:
Objective
Posture
Imbalances
• • •
Ocular Lock
Ocular Lock
• • •
OL Comments
Switched
What un-switched pt.
Upper Gait
Upper Gait
• • •
UG Notes
Lower Gait
Lower Gait
• • •
LG Notes
Plus
Plus
• • •
Plus Notes
Category
Cat. Select
• • •
Cat. Comments
ICV
D.A.P.E.S.
• • •
D.A.P.E.S. Notes
Emotions
Emotions
• • •
Today's Emotional Detail
Subluxation
• • •
Lovett Reactor
Lovett notes
Cranial Bones
Cranials Corrected
• • •
Acupuncture Meridian
Acupuncture therapy
• • •
Meridian Notes
Assesment
Standard Process
SP Given
Ecological Formula's
EF Given
Thorne Research
TR Given
Medi-herb
MH Given
Sport Supplement
Supplement Given
Patient responded well to treatment today?
Patient states:
• • •
Additional pt tx notes:
Plan
Patient will be re-evaluated:
Treatment schedule:
New Field

AK Visit Medical Form

Chiropractor

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Published: April 13, 2015, 4:17 p.m.
Doctor: Dr. History Physical
Rating: +10   /

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