|
Level of Pain
|
SUBJECTIVE
|
|
RESPONSE TO LAST TREATMENT
• • •
|
CURRENT PAIN
• • •
|
|
|
OBJECTIVE FINDINGS
|
|
MANIPULATION
|
|
|
CERVICAL - UPPER
|
CERVICAL - MID
|
|
CERVICAL - LOWER
|
|
|
THORACIC - UPPER
|
THORACIC - MID
|
|
THORACIC - LOWER
|
|
|
LUMBAR - UPPER
|
MID
|
|
LOWER
|
SI
|
|
EXTREMITY ADJ
|
|
|
|
|
|
MANUAL THERAPY
|
ACTIVE THERAPY
|
|
EDUCATION
|
|
|
|
|
|
|
|
|
DIAGNOSIS AND REFERRALS
|
|
|
DX CHANGED
|
COMMENTS
|
|
DX UNCHANGED
|
COMMENTS
|
|
CONT. TX AS PLANNED
|
COMMENTS
|
|
CHANGED TX PLAN
|
COMMENTS
|
|
ADDITIONAL DX WORK-UP
|
COMMENTS
|
|
REFER PATIENT
|
COMMENTS
|
