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Appointment Type
• • •
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CC
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HPI
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Date & Details of Accident
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Allergies
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Medications
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Review of Symptoms
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Past Medical HX
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Past Surgical HX
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Social HX
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Family HX
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ROS
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Physical Exam
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Cognitive
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Spinal Axis
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Gait and Station
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Cranial Nerves
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Sensory
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Motor Power
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Imaging
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Impression / Treatment Recommendations
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General [-]
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General [+]
• • •
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General Comments
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Skin [-]
|
Skin [+]
• • •
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Skin Comments
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HEENT [-]
|
HEENT [+]
• • •
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|
HEENT Comments
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Neck [-]
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Neck [+]
• • •
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Neck Comments
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Breasts [-]
|
Breasts [+]
• • •
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Breasts Comments
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Cardiovascular [-]
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Cardiovascular [+]
• • •
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CV Comments
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Respiratory [-]
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Respiratory [+]
• • •
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Resp Comments
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GI [-]
|
GI [+]
• • •
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GI Comments
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Urinary [-]
|
Urinary [+]
• • •
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Urinary Comments
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Genital (Male) [-]
|
Genital (Male) [+]
• • •
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Genital (Male) Comments
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Genital (Female) [-]
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Genital (Female) [+]
• • •
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Genital (Female) Comments
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Periph. Vasc. [-]
|
Periph. Vasc. [+]
• • •
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Periph. Vasc. Comments
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MSK [-]
|
MSK [+]
• • •
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|
MSK Comments
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Neurologic [-]
|
Neurologic [+]
• • •
|
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Neuro Comments
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Endocrine [-]
|
Endocrine [+]
• • •
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Endo Comments
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Psychiatric [-]
|
Psychiatric [+]
• • •
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|
Psychiatric Comments
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