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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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% 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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Spinal Palpation
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Spinal Palpation Comments
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Subluxation Complex
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Spinal Palp WNL
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spinal Observation/edema?
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Muscle Pain/Tenderness/Spasms
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Left hip
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Right hip
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Hip Observation
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Tenderness
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Left knee
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Right knee
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Knee Observation
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Tenderness
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Right Ankle
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Left Ankle
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Ankle Observation
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Tenderness
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Right Foot
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Left Foot
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Foot Observation
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Tenderness
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Lt. Shoulder
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Rt. Shoulder
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Shoulder Observation
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Tenderness
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Observation
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Pos. Orthos
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Neg Ortho
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Ranges of Motion
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Lt. Elbow
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Right Elbow
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Elbow Observation
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Tenderness
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Right Wrist
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Left Wrist
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Wrist observation
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Tenderness
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Right Hand/Fingers
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Left Hand/Fingers
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Hand Observation
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Tenderness
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Plan- improving
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Treatment Frequency
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Plan-at home
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Ice/Heat
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Manual Therapy Techniques 97140
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Therapeutic Activity 97530 59
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Therapeutic Exercise 97110 59
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Neuromuscular Re-Ed 97112 59
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EMS 97032
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Ice 97010
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Heat 97010
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Osteopathic Manipulation 98925
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Osteopathic Manipulation 98926
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73 Form 99080
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73 form comments and others
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Referrals
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