|
Treatment #
/
|
New Condition
|
|
Onset Date
|
CC
|
|
Subjective
• • •
|
General Comments
|
|
Quality of pain
• • •
|
Child Behavior
• • •
|
|
Aggravating Factors
• • •
|
Patient reports feeling sick/unwell
• • •
|
|
Relieving Factors
• • •
|
|
|
|
|
|
Facilitated Muscles
• • •
|
Inhibited Muscles
• • •
|
|
|
|
|
Muscle Spasm
• • •
|
Trigger Points
• • •
|
|
Subluxations
• • •
|
Extremities
• • •
|
|
|
Other
|
|
|
|
|
Adjusting Techniques
• • •
|
|
|
Soft Tissue Techniques
• • •
|
|
|
Therapeutic Exercises
• • •
|
At Home Instructions
• • •
|
|
LLT
• • •
|
|
|
Other Treatments
• • •
|
|
|
Assessment
• • •
|
|
|
Treatment Schedule
• • •
|
|
|
|
|
|
Patient Goals
|
Additional
|
|
|
|
|
Treatment tolerated
|
Follow up for next visit
|
|
|
|
|
|
|
|
|
Treatment
• • •
|
|
|
Follow up for next visit
• • •
|
|
|
Comment
|
