|
Pregnant
|
Weeks Pregnant
|
|
Subjective
|
Symptoms
|
|
Pain in
• • •
|
Anatomy pain locales
|
|
Pain level out of 10
/
|
Pain affects the patient
• • •
|
|
Objective
|
Posture
• • •
|
|
Cranial Nerve Test
• • •
|
Cranial Nerve Evaluation
|
|
DTR's
|
Myotomes
|
|
Grip strength Right/Left
/
|
Pain with Dynamometer
|
|
Visual Cervical ROM
|
Visual Lumbar ROM
|
|
Upper Orthopedic exams
• • •
|
Lower Body Orthopedic Tests
• • •
|
|
TMJ, C/S, T/S and UE
• • •
|
L/S and LE
• • •
|
|
ISD
• • •
|
Passive Therapies
• • •
|
|
Manipulation to
• • •
|
PIR
• • •
|
|
Therapeutic Activities/Therapeutic Exercise
• • •
|
Plan
|
|
Core strengthening exercises
• • •
|
Extremity Exercises
• • •
|
|
Neuromuscular Reeducation
• • •
|
Neuromobilisation
• • •
|
|
Kinesiotape
• • •
|
Restrictions
• • •
|
|
Treatment plan
• • •
|
Treatment duration
• • •
|
|
Supports or Therapeutic tools
• • •
|
Nutritional Recommendations
• • •
|
|
Imaging for
• • •
|
Referral
• • •
|
|
Therapy Tolerance
|
Signature
|
|
|
Additional Comments
|
