Current Pain
|
Cervical/thoracic
|
Last time's pain
|
Lumbar
|
Injection Number
|
|
Complications from Prev Inj
|
Prev inj Complications comments
|
Position
|
|
Area
|
|
Level
• • •
|
|
Medication Injected
• • •
|
|
Complications
|
Complication comments
|
Follow Up
• • •
|
Follow up comments
|