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Subjective
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Chief Complaint
|
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Diagram
|
CC Notes
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Progress
|
Intensity
|
|
Quality
• • •
|
Frequency
|
|
Duration
|
ADL
• • •
|
|
Aggravating Factors
• • •
|
Aggravating Factors Notes
|
|
Relieving Factors
• • •
|
Relieving Factors Notes
|
|
Tx Gains
• • •
|
Regression
• • •
|
|
No New Complaints
|
New Complaint
|
|
|
|
|
Objective
|
Objective Notes
|
|
ROM Diagram
|
ROM Notes
|
|
Observation
• • •
|
Observation reveals:
|
|
Hypertonicity
• • •
|
Tenderness Intensity
• • •
|
|
Tightness
• • •
|
Muscle Tone Notes
|
|
|
|
|
Chiropractic Evaluation
• • •
|
Chiropractic Eval Notes
|
|
|
|
|
Assessment
|
|
|
Assessment Notes
|
Exacerbation of Symptoms
|
|
Patient Response to Tx
|
Treatment Progress
• • •
|
|
Treatment Gains
• • •
|
Treatment Gains Notes
|
|
Treatment Challenges
• • •
|
Additional challenges in patient's progress...
|
|
Continued Care Warranted
|
MTB Reached
|
|
Prognosis
|
|
|
Prognosis
• • •
|
|
|
|
|
|
Plan
|
|
|
Adjustments
• • •
|
Extremity CMT
|
|
Vibracussor
• • •
|
Vibracussor Duration
|
|
MFRT
• • •
|
MFRT Duration
|
|
Plan Notes
|
|
|
Post Tx Notes
|
Home Care Issued (Note: Leave first line blank)
|
|
Post Treatment Response
|
|
|
X-Ray Orders
• • •
|
|
|
MRI Orders
• • •
|
Blood Work Orders
• • •
|
