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Body diagram
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General impression, Gait, Posture, Movement
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Adhesion sites/Tenderness notes (Do not leave blank!!)
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Adhesion sites/Tenderness - ThoracoLumboSacral
• • •
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Adhesion sites/Tenderness - Hip/Thigh
• • •
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Adhesion sites/Tenderness DETAIL notes
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Adhesion sites/Tenderness - Ankle/Foot
• • •
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Adhesion sites/Tenderness - Lower leg
• • •
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Lumbar
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Lumbar Exam notes
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Lumbar ROM
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Flex N:80
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Ext N:40
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LLF N:30
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RLF N:30
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LR N:40
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RR N:40
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Lumbar ROM notes
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Lumbar Ortho
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Antalgia L
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Antalgia R
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Listing (flex) L
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Listing (flex) R
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Gillet L
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Gillet R
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Trendelenberg L
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Trendelenberg R
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Kemp's L
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Kemp's R
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Lumbosacral Posterior Translation L
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Lumbosacral Posterior Translation R
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L-P rhythm L
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L-P rhythm R
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Valsava
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Seated flexion
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Slump L
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Slump R
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SLR/Lasegue L
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degree of SLR
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SLR/Lasegue R
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degree of SLR
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Goldthwait L
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Goldthwait R
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Leg length L
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Leg Length R
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Modified Thomas L
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Modified Thomas R
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Toe walk L
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Toe walk R
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Heel walk L
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Heel walk R
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Lumbar ortho notes
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Lumbar ortho notes
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Neuro
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Neuro comments
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L1 S L
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S R
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M L
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M R
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L2 S L
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S R
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M L
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M R
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L3 S L
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S R
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M L
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M R
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L4 S L
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S R
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M L
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M R
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DTR L
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DTR R
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L5 S L
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S R
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M L
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M R
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DTR L
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DTR R
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S1 S L
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S R
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M L
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M R
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DTR L
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DTR R
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Neuro test notes
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Neuro test notes
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Rad: reviews?
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View
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Finding
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Rad notes
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Peripheral nerve entrapment
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Nerve entrapment notes
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Sciatic
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Femoral, cluneal
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Sciatic, post tibial, common/deep/supf peroneal
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Post tibial, med plantar
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Hip
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Hip ROM
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FL L N:150
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FL R N:150
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ER L N:50
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ER R N:50
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IR L N:40
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IR R N:40
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Abd L N:50
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Abd R N:50
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Add L N:30
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Add R N:30
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Ext L N:30
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Ext R N:30
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Hip ROM notes
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Hip Ortho
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Fabere L
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Fabere R
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Allis L
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Allis R
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Anvil L
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Anvil R
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Scour L
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Scour R
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Craig's L
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Craig's R
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Hip Ortho notes
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Hip Ortho notes
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Knee
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Knee ROM
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FL L N:150
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FL R N:150
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Ex L N:0
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Ex R N:0
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IR L N:5
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IR R N:5
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ER L N:10
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ER R N:10
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Knee ROM notes
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Knee Ortho
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Valgus L
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Valgus R
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Varus L
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Varus R
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Drawer - Ant L
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Drawer - Ant R
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Drawer - Post L
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Drawer - Post R
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Lachman L
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Lachman R
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Steinman L
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Steinman R
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McMurray L
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McMurray R
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Flex+rot L
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Flex+rot R
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Noble's L
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Noble's R
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Patella mobility L
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Patella mobility R
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Knee ortho notes
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Knee ortho notes
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Ankle and Foot
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Ankle ROM
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Plantarflexion L N:40
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Plantarflexion R N:40
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Dorsiflexion L N:25
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Dorsiflexion R N:25
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Pron L N:10
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Pron R N:10
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Supn L N:20
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Supn R N:20
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Ankle ROM Notes
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Ankle/foot Ortho
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Drawer - Ant L
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Drawer - Ant R
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Drawer - Post L
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Drawer - Post R
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Valgus L
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Valgus R
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Varus L
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Varus R
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Squeeze L
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Squeeze R
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1st toe ext L
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1st toe ext R
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Hagland L
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R
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Rear vl/vr L
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R
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Over-pronation / Dropped arch L
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R
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1st ray mob L
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R
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Ankle/foot ortho notes
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Ankle/foot ortho notes
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Pulse Dx
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Pulse diagram
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(R) Cun:
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(R) Guan:
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(R) Chi:
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(L) Cun:
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(L) Guan:
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(L) Chi:
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Pulse (R)
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Pulse (L)
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