|
Time
|
|
|
Subjective
|
Present Since
|
|
Commenced as a result of:
|
Present Symptoms
• • •
|
|
Symptoms at Onset
• • •
|
Better
• • •
|
|
Worse
• • •
|
Correction of posture
• • •
|
|
Posture
• • •
|
Motor deficits
• • •
|
|
Dermatomes
• • •
|
Reflexes
• • •
|
|
Movement loss flexion
• • •
|
Movement loss extension
• • •
|
|
Movement loss protraction
• • •
|
Movement loss retraction
• • •
|
|
Movement loss right rotation
• • •
|
Movement loss left rotation
• • •
|
|
Movement loss right side bending
• • •
|
Movement loss left side bending
• • •
|
|
Movement loss thoracic flexion
• • •
|
Movement loss thoracic extension
• • •
|
|
Repeated protraction
• • •
|
Repeated retraction
• • •
|
|
Repeated flexion
• • •
|
Repeated extension
• • •
|
|
Repeated right rotation
• • •
|
Repeated left rotation
• • •
|
|
Repeated right side bending
• • •
|
Repeated left side bending
• • •
|
|
Repeated thoracic flexion
• • •
|
Repeated thoracic extension
• • •
|
|
Other tests
|
|
|
Assessment
|
|
|
Goal 2
|
Goal 1
|
|
|
Goal 3
|
|
Rehab potential
|
Treatment Plan
|
|
Visits per week
• • •
|
Duration
• • •
|
|
|
|
|
Today's STM
• • •
|
Joint Mobs
|
|
Exercises
|
Home Exercise Program
|
|
Self Care
|
|
|
MD Signature
|
|
