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Chief Complaint
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Diagram
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CC Notes
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Progress
|
Intensity
|
|
Quality
• • •
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Frequency
|
|
Duration
|
ADL
• • •
|
|
Aggravating Factors
• • •
|
Aggravating Factors Notes
|
|
Relieving Factors
• • •
|
Relieving Factors Notes
|
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Tx Gains
• • •
|
Regression
• • •
|
|
No New Complaints
|
New Complaint
|
|
|
|
|
ROM Diagram
|
ROM Notes
|
|
Observation
• • •
|
Observation Comments
|
|
Hypertonicity
• • •
|
Tenderness Intensity
• • •
|
|
Tightness
• • •
|
Muscle Tone Notes
|
|
|
|
|
Chiropractic Evaluation
• • •
|
Chiropractic Eval Notes
|
|
|
|
|
Assessment Notes
|
Exacerbation of Symptoms
|
|
Patient Response to Tx
|
Treatment Progress
• • •
|
|
Treatment Gains
• • •
|
Treatment Gains Notes
|
|
Treatment Challenges
• • •
|
Treatment Challenges Notes
|
|
Continued Care Warranted
|
MTB Reached
|
|
Prognosis
|
|
|
|
|
|
Spinal CMT
• • •
|
Extremity CMT
|
|
ART
• • •
|
ART Duration
|
|
PIR
• • •
|
PIR Duration
|
|
Static Stretching
• • •
|
Stretching Duration
|
|
STM
• • •
|
STM Duration
|
|
IASTM
• • •
|
IASTM Duration
|
|
Hot Pack
• • •
|
Hot Pack Duration
|
|
Ice Pack
• • •
|
Ice Pack Duration
|
|
IFC
• • •
|
IFC Duration
|
|
US
• • •
|
US Setting
|
|
LLLT
• • •
|
KT
• • •
|
|
Exericse
• • •
|
Exercise Duration
|
|
Nurtitional/ Botanical Supplements
• • •
|
Home Care
• • •
|
|
Post Treatment Response
|
Post Tx Notes
|
|
|
|
|
X-Ray Orders
• • •
|
Blood Work Orders
• • •
|
|
MRI Orders
• • •
|
|
