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New Complaint
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Wellness Care
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Site
• • •
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around
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Onset
• • •
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Mechanism (pt reports...)
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Quality
• • •
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Ref/Rad to the:
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Intensity (Now, Worst, Best)
• • •
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Freq/Timing
• • •
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Provocative
• • •
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Provocative
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Palliative
• • •
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Palliative comments
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Progression
• • •
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Previous Care
• • •
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Associated Symptoms
• • •
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RE-EXAM Performed
|
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Observation
• • •
|
Observation Comments
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|
Range of Motion (decreased)
• • •
|
Describe
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|
Range of Motion:
|
reproduced the CC
|
|
Neuros WNL
|
|
|
Motor (0-5)
• • •
|
Sensory
• • •
|
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DTR
• • •
|
Cranial Nerves
• • •
|
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Neuro Comments
|
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Positive Orthos
• • •
|
Orthopedic Testing
|
|
reproduced CC
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Records Reviewed
• • •
|
|
|
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Continuing Care
|
Maintenance Visit
|
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Progress
• • •
|
The patient reports...
|
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Intensity (0-10)
• • •
|
|
|
|
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Observation
|
|
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Segmental Joint Play
• • •
|
Technique Used
• • •
|
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Tenderness to Palpation (Upper)
• • •
|
Tenderness to Palpation (Lower)
• • •
|
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Tenderness to Palpation
|
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Hypertonicity (Upper)
• • •
|
Hypertonicity (Lower)
• • •
|
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Hypertonicity
|
|
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CMT 1-2 Regions
|
CMT 3-4 Regions
|
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Extremity Adjustment (98943)
|
NMR
|
|
Corrective Exercises
• • •
|
Corrective Exercises
|
|
Modalities
• • •
|
Comments
|
|
NMR Performed
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MRT Performed
|
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IASTM Performed
|
MarcPro Placement
|
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Cupping Placement
|
|
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Treatment Plan
• • •
|
Treamtent Plan
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