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Duration of Low back pain
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Do you have right buttock radiating pain?
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Do you have left buttock radiating pain?
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Do you have right lower extremity radiating pain
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If yes, specify areas
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If yes, intensity
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Do you have left lower extremity radiating pain
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If yes, specify areas
• • •
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If yes, intensity
• • •
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Do you have low back pain?
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If yes, intensity
• • •
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Right lower extremity numbness and tingling?
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If yes, specify areas
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If yes, intensity
• • •
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Left lower extremity numbness and tingling?
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If yes, specify areas
• • •
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If yes, intensity
• • •
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Do you have bladder disfunction?
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Do you have bowel disfunction?
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Lumbar condition treatment
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If epidural injection was selected, how many
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