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Exam Type:
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No Accident:
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Date of Accident:
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Body parts injured:
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Accident Info:
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Subjective:
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CHIEF COMPLAINT:
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Main Problem Dictation:
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Pain Level:
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Pain Level Change:
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Current Meds:
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Heartburn:
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On blood thinners:
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Duration:
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Onset no accident:
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Job activity has repetitive elbow strain?
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Onset accident:
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Decreased Pain:
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Increased Pain:
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F/U on PT:
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No Prior Treatment:
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Prior Treatment:
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Previous Problem/Injury:
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Previous Problem/Injury Dictation:
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Objective:
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Exam deferred to next visit:
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Maximum site of pain:
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Range of Motion:
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Triceps:
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Biceps:
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Lateral Epicondyle Humerus:
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Medial Epicondyle of the Humerus:
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Olecranon:
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Radial Head:
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Neurovascular:
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Ulnar Groove:
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Correlation:
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Aggrevation:
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X-Rays:
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Xray Report:
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MRI:
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MRI Dictation:
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Assessment:
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Assessment:
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Assessment Dictation:
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2ndry to MVA:
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Accident aggravated PP:
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2ndry to slip & fall:
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Slip & fall aggravated PP:
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Surgery Discussion:
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Plan:
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Return Appointment:
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Work Status:
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P.T. 1 x visit:
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No Work:
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Stressed home/formal PT:
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Reinstructed in home PT:
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Counseled in smoking:
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WT DISCUSSION AGREED/DECLINED:
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Durable Medical Goods:
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Disposition:
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Kasper:
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Continue meds other source:
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Patient currently in Pain Management:
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Heartburn:
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Medications:
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No Meds:
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Cautioned Medication:
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C & I blood thinners:
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Final Discharge Options:
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Patient is Released:
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