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Exam Findings
HRV - See Attached
Thermal Scan - See Attached
EMG- See Attached
Radiology - See Attached
Cranial Nerves - See Attached
Posture - See Attached
FMS - See Attached
ADL - See Attached
Symptom Survey - See Attached
Cervical - Tenderness
• • •
Edema
• • •
Spasm
• • •
Thoracic- Tenderness
• • •
Edema
• • •
Spasm
• • •
Lumbar - Tenderness
• • •
Edema
• • •
Spasm
• • •
Turn on - Muscle Grading
Turn On - Reflex Grading
Headers Turn on - Cervical ROM
C1, 2 Flexion
Degrees
• • •
C1, 2 Extension
Degrees
• • •
C3 Rt Lat Flex
Degrees
• • •
C3 Lt Lat Flex
Degrees
• • •
C4, XI Rt Rot
Degrees
• • •
C4, XI Lt Rot
Degrees
• • •
Nerve Root Headers Turn on
C5 - Deltoid / Abd
Right
Left
Bicep Reflex Right
Bicep Reflex Left
Sensation
C6 - Bi Flex & Wrst Ext
Right
Left
Brachioradialis Reflex Right
Brachioradialis Reflex Left
Sensation
C7 - Tri Ext & Wrist Flex
Right
Left
Tricep Reflex Right
Tricep Reflex Left
Sensation
C8 - Finger Flex
Right
Left
Sensation
T1 - Finger Abd
Right
Left
Sensation
Headers Turn on - Lumbar ROM
L1-5 Flexion
Degrees
• • •
L1-5 Extension
Degrees
• • •
L1-5 Rt Lat Flex
Degrees
• • •
L1-5 Lt Lat Flex
Degrees
• • •
Nerve Root Headers Turn on
L1 - Psoas / Hip Flex
Right
Left
Sensation
L2 - Quad / Knee Ext
Right
Left
Sensation
L3 - Sartorius / Drag
Right
Left
Patellar Reflex Right
Patellar Reflex Left
Sensation
L4 - Hams / Knee Flex
Right
Left
Sensation
L4 - Foot Inversion
Right
Left
Sensation
L5 - F/T Dorsiflexion
Right
Left
Sensation
S1 - Foot Eversion
Right
Left
Achilles Reflex Right
Achilles Reflex Left
Sensation
Public Bone
Right
Left
Charges
• • •

Chiropractic Evaluation Medical Form

Chiropractor

Chiropractic Evaluation

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Published: June 9, 2015, 9:19 a.m.
Doctor: Dr. History Physical
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