|
Subjective
|
|
|
Chief Complaint
• • •
|
Frequency of Symptoms
|
|
Symptoms
• • •
|
VAS
/
|
|
Aggravating Factors
• • •
|
Relieving Factors
• • •
|
|
|
|
|
Secondary Complaint
|
|
|
2nd Complaint
|
Complaint
• • •
|
|
Frequency of Symptoms
|
Symptoms
• • •
|
|
VAS
/
|
|
|
Aggravating Factors
• • •
|
Relieving Factors
• • •
|
|
Area of symptoms
|
|
|
Additional Comments
|
|
|
Objective
|
|
|
Palpatory Tenderness
• • •
|
Hypertonicity/Spasm
• • •
|
|
Spinal Listing
• • •
|
Extremity Finding
• • •
|
|
Upper Extremity Muscles
• • •
|
Lower Extremity
• • •
|
|
Spine
|
|
|
|
|
|
Assessment
|
|
|
Patient Progress
• • •
|
Secondary Progress.
• • •
|
|
Observation
• • •
|
Patient's Overall Progress
|
|
Prognosis
|
|
|
Plan
|
|
|
Goal to Increase
• • •
|
Goal to Reduce
• • •
|
|
Tolerated Treatment?
|
Therapy was without incident
|
|
Treatment Plan
|
|
|
Therapy's Performed
• • •
|
Seg. Adjusted
• • •
|
|
Extremity Adjustment
• • •
|
Extremity Vector
• • •
|
|
Muscle Work
• • •
|
Exercises
• • •
|
|
ADL Instructions
• • •
|
Home Instructions
• • •
|
|
|
DME
|
|
Nutrition
|
Nutrition Comments
|
|
Education
|
Education Comments
|
|
Referrals
|
Referral Comments
|
|
Radiology
• • •
|
Radiology Comments
|
|
Labs
• • •
|
Lab Comments
|
