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ALERT
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Alert Comment
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Chief Complaint, Location and Onset
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Pain severity today (0-10)
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Pain severity today (mild/mod/sev)
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Changes since last visit
• • •
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Other, please specify
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Quality of pain
• • •
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Temporal change/timing
• • •
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Pain at worst
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Pain is felt __% of time
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Pain improves with
• • •
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Other, please specify
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Pain is worse with
• • •
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Other, please specify
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Limitations
• • •
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Other please specify
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Patient had imaging done previously
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Comments
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Patient takes medication to address his/her condition
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Comments
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SECONDARY CCs
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OTHER BODILY PAIN:
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SLEEP/ENERGY
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STRESS/MOOD
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DIGESTION
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OTHER
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Medical history, diagnoses, medications, conditions, surgeries, illnesses, or issues
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