|
Chief Complaint
• • •
|
CC status
|
|
% of day?
|
Other Symptoms
• • •
|
|
Severity of CC pain
|
Quality of pain
• • •
|
|
Intensity Now
|
Worst intensity
|
|
Radiate?
|
If yes, Where?
|
|
Aggravating Factors
• • •
|
Relieving Factors
• • •
|
|
Complaint #2
|
|
|
Complaint #2
• • •
|
Complaint #2 status
|
|
% of day?
|
Other Symptoms
• • •
|
|
Severity of Complaint #2 pain
|
Quality of pain
• • •
|
|
Intensity Now
|
Worst intensity
|
|
Radiate?
|
If yes, Where?
|
|
Aggravating Factors
• • •
|
Relieving Factors
• • •
|
|
Complaint #3
|
|
|
Complaint #3
• • •
|
Complaint #3 status
|
|
% of day?
|
Other Symptoms
• • •
|
|
Severity of CC pain
|
Quality of pain
• • •
|
|
Intensity Now
|
Worst intensity
|
|
Radiate?
|
If yes, Where?
|
|
Aggravating Factors
• • •
|
Relieving Factors
• • •
|
|
Complaint #4
|
|
|
Complaint #4
• • •
|
Complaint #4 status
|
|
% of day?
|
Other Symptoms
• • •
|
|
Severity of CC pain
|
Quality of pain
• • •
|
|
Intensity Now
|
Worst intensity
|
|
Radiate?
|
If yes, Where?
|
|
Aggravating Factors
• • •
|
Relieving Factors
• • •
|
|
Range of motion
• • •
|
Pain Diagram
|
|
Muscle Tightness
|
Reduced Spinal ROM
• • •
|
|
L Spasm and Tenderness
• • •
|
R Spasm and Tenderness
• • •
|
|
C/S L muscle tightness
|
C/S R muscle tightness
|
|
T/S L muscle tightness
|
T/S R muscle tightness
|
|
L/S L muscle tightness
|
L/S R muscle tightness
|
|
Pelvic L muscle tightness
|
Pelvic R muscle tightness
|
|
Cervical Subluxation Complex
• • •
|
Thoracic Subluxation Complex
• • •
|
|
Lumbar Subluxation Complex
• • •
|
|
|
Spinal Palpation/Adjustment
• • •
|
Extremity ROM/Adjustment
• • •
|
|
Diversified/Drop Table
|
Activator
|
|
Chiropractic Adjustments 98940
• • •
|
Chiropractic Adjustments 98941
• • •
|
|
Extraspinal Adjustments 98943
• • •
|
Wellness Adjustment
|
|
Hydromassage Therapy 97039 59
• • •
|
Spinal Diagram
|
|
Cold Laser
• • •
|
Inversion Table
|
|
Intersegmental Traction
|
Moist Heat
|
|
Ultrasound
|
BEMER
|
|
Acupuncture
|
Spinal Decompression
|
|
KT
• • •
|
Muscle Stimulation
• • •
|
|
Short Term Goals
• • •
|
Long Term Goals
• • •
|
|
Neck Index Goals
• • •
|
Oswesty Goals
• • •
|
|
Exericse
• • •
|
Plan-at home
• • •
|
|
Plan- improving
• • •
|
Treatment Schedule
• • •
|
|
Function
• • •
|
Response to tx
|
|
General assessment
|
X-Ray Orders
• • •
|
|
Blood Work Orders
• • •
|
X-RAYS
• • •
|
