Pain
|
Level of Pain
|
Type/location
|
|
|
|
Follow up
|
|
Follow up 1
|
Follow up interval
• • •
|
Condition
|
Status
• • •
|
Treatments tried
|
Treatments
• • •
|
Names of treatments
|
Other
|
|
|
Follow up 2
|
Follow up interval
• • •
|
Condition
|
Status
• • •
|
Treatments tried
|
Treatments tried
• • •
|
Names of treatments
|
Other
|
|
|
New complaint
|
|
New complaint 1
|
|
New complaint 1
|
New complaint comments
|
Location
• • •
|
Location comments
|
Duration
|
Duration comments
|
Modifying factors
• • •
|
Modifying factors comments
|
Chononology
• • •
|
Chronology comments
|
Associated symptoms
• • •
|
Associated symptoms comments
|
Previous treatments used
• • •
|
Previous treatments comments
|
|
|
New complaint 2
|
|
New complaint 2
|
New complaint comments
|
Location
• • •
|
Location comments
|
Duration
|
Duration comments
|
Modifying factors
• • •
|
Modifying factors comments
|
Chononology
• • •
|
Chronology comments
|
Associated symptoms
• • •
|
Associated symptoms comments
|
Previous treatments used
• • •
|
Previous treatments comments
|
|
|
New complaint 3
|
|
New complaint 3
|
New complaint comments
|
Location
• • •
|
Location comments
|
Duration
|
Duration comments
|
Modifying factors
• • •
|
Modifying factors comments
|
Chononology
• • •
|
Chronology comments
|
Associated symptoms
• • •
|
Associated symptoms comments
|
Previous treatments used
• • •
|
Previous treatments comments
|
|
|
New complaint 4
|
|
New complaint 4
|
New complaint comments
|
Location
• • •
|
Location comments
|
Duration
|
Duration comments
|
Modifying factors
• • •
|
Modifying factors comments
|
Chononology
• • •
|
Chronology comments
|
Associated symptoms
• • •
|
Associated symptoms comments
|
Previous treatments used
• • •
|
Previous treatments comments
|
|
|
New complaint 5
|
|
New complaint 5
|
New complaint comments
|
Location
• • •
|
Location comments
|
Duration
|
Duration comments
|
Modifying factors
• • •
|
Modifying factors comments
|
Chononology
• • •
|
Chronology comments
|
Associated symptoms
• • •
|
Associated symptoms comments
|
Previous treatments used
• • •
|
Previous treatments comments
|