|
HPI
|
|
|
Location
• • •
|
Location Comments
|
|
Facial pain
• • •
|
Ear pain
• • •
|
|
clenching
• • •
|
headaches
• • •
|
|
jaw pain
• • •
|
|
|
Quality
• • •
|
Quality Comments
|
|
Severity
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset / Timing
• • •
|
Onset Comments
|
|
Context
• • •
|
Context Comments
|
|
Modifying Factors
• • •
|
Modifying Factors Comments
|
|
Associated Symptoms
• • •
|
Associated Symptoms Comments
|
|
Previous Treatment
|
|
|
Physical
|
|
|
General WNL
|
General Abnormal
• • •
|
|
General Comments
|
HEENT WNL
|
|
HEENT Abnormal
• • •
|
HEENT Comments
|
|
Jaw
• • •
|
|
|
Skin WNL
|
Skin Lesion
|
|
Skin Comments
|
Neck WNL
|
|
Neck Abnormal
• • •
|
Neck Comments
|
|
Cardiovascular WNL
|
Cardiovascular Abnormal
• • •
|
|
Cardiovascular Comments
|
Lungs WNL
|
|
Lungs Abnormal
• • •
|
Lungs Comments
|
|
Neuro WNL
|
Neuro Abnormal
• • •
|
|
Neuro Comments
|
Extremities WNL
|
|
ASSESSMENT
|
|
|
Assessment
|
|
|
PLAN
|
|
|
Plan
|
|
