|
TE1 - 15 MIN
|
TE2 - 30 MIN
|
|
TE3 - 45 MIN
|
TE4 - 60 MIN
|
|
TYPE OR ROM
|
Comment
|
|
Passive ROM
|
AAROM
|
|
AROM
|
RESISTIVE ROM
|
|
Manually Resisted Therapeutic Exercise
|
PNF technique
|
|
Providers Involved in Today's Tx (Required)
|
Other procedures performed? List here
|
|
BODY REGION(S)
|
Comment
|
|
Neck
• • •
|
Trunk
• • •
|
|
Hip
• • •
|
Knee
• • •
|
|
Ankle
• • •
|
Comment
|
|
Shoulder
• • •
|
Elbow
• • •
|
|
Wrist
• • •
|
Other
|
|
Therapeutic activities
|
|
|
PNF/sustained stretch
|
|
|
PNF/Sustained stretch Region
• • •
|
Comment
|
|
Graston
|
|
|
Graston Region
• • •
|
Comments
|
|
Cranio-sacral therapy KA 97530
|
Cranio-Sacral Tx Region
• • •
|
|
Kinesiotaping TE1- 97110
|
|
|
Kinesiotaping Region
• • •
|
Comments
|
|
Traction 97012
|
|
|
Traction region
• • •
|
Comment
|
|
Therapeutic exercises
|
|
|
Upper Quadrant Stretches
• • •
|
Comment
|
|
Middle Back Stretch
• • •
|
Comment
|
|
Upper Quadrant Exercises:
• • •
|
Comment
|
|
Lower Quadrant Stretches
• • •
|
Comment
|
|
Lower Quadrant Exercises:
• • •
|
Comment
|
