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Vascular Evaluation:
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Vascular Evaluation
• • •
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Vascular comments
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Neurological Exam:
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Normal Neuro Exam
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Abnormal Neurological exam findings
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Dermatologic Exam:
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Normal Derm Exam
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Dermatology Comments
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Callous location
• • •
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Musculoskeletal Exam:
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Normal Muscle Strength
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Musculoskeletal comments:
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Presence of Gastrocnemius Equinus
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Comments
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Bunion deformity Location
• • •
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Comments
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Location Pain 1st MPJ
• • •
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Comments
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Pain sub 2nd MPJ
• • •
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Additional area Pain
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1st Ray hyper mobility present?
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Comments
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1st MPJ ROM Normal Right
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Normal 1st MPJ ROM Left
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Abnormal ROM testing Right 1st MPJ
• • •
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Abnormal 1st MPJ ROM L
• • •
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Pain with ROM 1st MPJ R
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Pain Left 1st MPJ
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Quality ROM R 1st MPJ
• • •
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Quality Motion L 1st MPJ
• • •
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HIPJ R
• • •
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HIPJ L
• • •
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Gait Evaluation
• • •
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Comments
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Associated Deformities
• • •
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New Short Text Field
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Radiology Evaluation:
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Radiographic Findings Angular Right
• • •
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Radiographic Findings Angular Left
• • •
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Radiographic Anatomy Right
• • •
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Radiographic Anatomy Left
• • •
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Radiograph/ diagram
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