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SUBJECTIVE: Patient reports
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CC#1
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CC#1pain ___/10
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CC#2
• • •
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CC#2: Pain _____/10
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CC#3
• • •
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CC#3: Pain _____/10
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Symptoms
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Disability index % (#)
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Improvement % (#)
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regressed % (#)
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ADL's
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Comments ADLs
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Home Care
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Comment Home care
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Comments
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OBJECTIVE
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Cervical ROM
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cervical ROM pain
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Dorsolumbar ROM
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Dorsolumbar ROM pain
• • •
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T/S:____
• • •
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SI
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L/S:____
• • •
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Subluxation levels: C/S:____
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ext/rib hypo
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Tenderness
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Cervical Muscle spams
• • •
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cervical muscle tendernes
• • •
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Thoracic Muscle spams
• • •
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thoracic muscle pain
• • •
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Lumbar Muscle spams
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lumbar muscle pain
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Posture and leg length
• • •
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Monitored Orthopedics (T)
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Progress
• • •
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Antalgic /gait
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Comments
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Phase of Care
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ASSESSMENT
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ST Goals:______
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LT goals
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Additional Assessment/orthopedics
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PLAN
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T/S:____
• • •
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C/S:____
• • •
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L/S:____
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SI
• • •
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extremity adj type it out
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Ice
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Graston Area
• • •
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Graston time
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Therapeutic Exercise: Areas___
• • •
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Therapuetic stretches
• • •
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Kinesio Tape
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Treatment plan
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Follow up on
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Change in treatment plan
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Treated by
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