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Subjective:
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CC/History Header
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Outcome Assessments
• • •
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Acute/Chronic
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Body Part
• • •
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Chief Complaint/History
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Has past family history.
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Treatment to Date
• • •
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Occupation
• • •
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Work Status
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Work Habits
• • •
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Activities
• • •
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Activity Status
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ADL's cause pain
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Pain Header
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Areas of Pain Default
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Pain Scale At Rest
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Pain Scale During Activity
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Pain Scale At Its Best
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Pain at it's worst
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Pain Scale Right Now
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Objective:
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Gait Header
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Gait
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Antalgic Gait Traits
• • •
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Observations
• • •
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Palpation Bony & Ligamentous
• • •
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Palpation soft tissue
• • •
|
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Range of Motion Header
|
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Range of Motion Default
|
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Special Tests and MMT Header
|
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UE/LE Ortho Positive
• • •
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UE/LE Ortho Negative
• • •
|
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Positive Spine Orthos
• • •
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Negative Spine Orthos
• • •
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MMT
|
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Treatment/HEP Header
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HEP
|
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Notes Header
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Other Notes
|
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Assessment:
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Assessment
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Plan:
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Follow-Up
|
Plan of Care
• • •
|
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Short Term Goals
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Long Term Goals
|
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Treatment Time
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Referral
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