|
Subjective
|
|
|
Wellness care
|
No Change
|
|
overall progress
|
(how/why)
|
|
Intensity Now
|
intensity now (comment)
|
|
Worst intensity
|
Worst intensity (comment)
|
|
% Perceived improvement
|
What is better/worse
|
|
ADLs
|
ADLs (comment)
|
|
Other Pt comments
|
Other Changes
|
|
Objective
|
|
|
Postural abnormalities
• • •
|
|
|
Cervical AROM-WNL
|
Cervical AROM
• • •
|
|
|
Cervical AROM (comment)
|
|
Trunk AROM WNL
|
Trunk AROM
• • •
|
|
|
Trunk AROM (comment)
|
|
Switching negative
|
Swtiching
• • •
|
|
Abnormal gait
|
Normal gait
|
|
|
|
|
Muscle Test
|
|
|
Muscle weaknesses
|
|
|
Cervical mm
• • •
|
|
|
left upper extremity
• • •
|
right upper extremity
• • •
|
|
left LB/lower extremity
• • •
|
right LB/lower extremity
• • •
|
|
|
|
|
Spinal listing
|
|
|
Spinal listings
|
No Spine CMT
|
|
|
|
|
739.1 cervical region
|
|
|
Occiput
• • •
|
C1
• • •
|
|
C2
• • •
|
C3
• • •
|
|
C4
• • •
|
C5
• • •
|
|
C6
• • •
|
C7
• • •
|
|
|
|
|
739.2 thoraic region
|
|
|
T1
• • •
|
T2
• • •
|
|
T3
• • •
|
T4
• • •
|
|
T5
• • •
|
T6
• • •
|
|
T7
• • •
|
T8
• • •
|
|
T9
• • •
|
T10
• • •
|
|
T11
• • •
|
T12
• • •
|
|
|
|
|
739.3 lumbar region
|
L1
• • •
|
|
L2
• • •
|
L3
• • •
|
|
L4
• • •
|
L5
• • •
|
|
|
|
|
739.5 pelvic region
|
Pelvis
• • •
|
|
Pelvic Categories
• • •
|
Pubic symphysis
• • •
|
|
739.4 sacral region
|
Coccyx
• • •
|
|
|
Sacrum
• • •
|
|
Spinal joint play
• • •
|
|
|
|
|
|
Upper extremity listings
|
|
|
Left shoulder girdle
• • •
|
Right shoulder girdle
• • •
|
|
Left Elbow
• • •
|
Right Elbow
• • •
|
|
Left wrist/hand
• • •
|
Right Wrist/hand
• • •
|
|
Lower extremity listings
|
|
|
Left hip
• • •
|
Right Hip
• • •
|
|
Left knee
• • •
|
right Knee
• • •
|
|
Left ankle/foot
• • •
|
Right Ankle/foot
• • •
|
|
|
|
|
Extremity joint play
• • •
|
Crainials
• • •
|
|
|
|
|
Tissue change 1
• • •
|
tissue 1 region
|
|
Tissue change 2
• • •
|
Tissue 2 region
|
|
Tissue change 3
• • •
|
Tissue 3 region
|
|
Tissue change 4
• • •
|
tissue 4 region
|
|
Tissue change 5
• • •
|
tissue 5 region
|
|
Tissue change 6
• • •
|
tissue 6 region
|
|
Therapeutic Procedures
|
|
|
Cold Laser 97039
|
Cold Laser Region
• • •
|
|
Graston
|
Graston Region
• • •
|
|
MRT 97124
|
MRT Region
• • •
|
|
Muscle stim 97014
|
stim region
• • •
|
|
Ultrasound/combo 97128
|
US/combo region
• • •
|
|
Traction 97012
|
traction region
• • •
|
|
vibracussor 97124
|
vibracussor region
• • •
|
|
Ice/Heat PT 97010
• • •
|
Ice/heat PT region
• • •
|
|
|
|
|
General assessment
|
General assessment (Comment)
|
|
Response to tx
|
Response to Tx (comment)
|
|
Compliance
• • •
|
Compliance (comment)
|
|
|
|
|
CMT 1-2 98940
|
CMT 3-4 98941
|
|
CMT 5-6 98942
|
CMT extremity
|
