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Chief Complaint
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Chief Complaint Comments
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Office Visit
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Office Visit Comments
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CC status
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CC Status Comments
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Pain Scale
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% of day?
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% of the day Comments
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Quality of pain
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Quality of Pain Comments
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Relieving Factors
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Relieving Factors Comments
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Aggravating Factors
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Aggravating Factors Comments
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Symp. worst when?
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Timing of Symptoms Comments
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Spinal Palpation
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Spinal Palpation Comments
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Muscle Pain/Tenderness/Spasms
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Posture Analysis
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Gait
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Subluxation Complex
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Range of motion
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Range of Motion Comments
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Positive Orthopedic Tests
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Other Objective Comments
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Function
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Treatment Schedule
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Function Comments
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Referrals
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Wellness Adjustment
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Plan- improving
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Chiropractic Adjustments 98940
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Chiropractic Adjustments 98942
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Chiropractic Adjustments 98941
• • •
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Extraspinal Adjustments 98943
• • •
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Plan-at home
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Manual Therapy Techniques 97140
• • •
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Electrical Stim Unattended 97014
• • •
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Therapeutic Exercise 97110 59
• • •
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Mechanical Traction 97012
• • •
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Cold/Hot Pack 97010
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Ultrasound Therapy 97035
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Neuromuscular Re-Ed 97112 59
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X-RAYS
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Xray Comments
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