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Everyone
|
|
|
# of Treatments till Reevaluation
/
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|
|
Daily S.O.A.P Note
|
|
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Onset Date
|
The cause of injury/pain
• • •
|
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What does the patient say today?
|
Dr. Comments (Inc. Dr. name and CMC)
|
|
Aggravating Factors
• • •
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Relieving Factors
• • •
|
|
0-10 Scale of Pain
• • •
|
Quality of pain
• • •
|
|
Treatment goals
• • •
|
Medications
|
|
Health History
• • •
|
Lymphatic System
• • •
|
|
Doctor
|
Massage Therapists
|
|
Show The Exam Findings (NP Exam, Re-evals Only)
|
Lymphedema diagnosis
|
|
|
|
|
Subluxations C1-7
• • •
|
Cervical Muscle Spasms
• • •
|
|
|
Mild, Moderate, Severe
|
|
Subluxations T1-12
• • •
|
Thoracic Muscle Spasms
• • •
|
|
|
Mild, Moderate, Severe
|
|
Subluxations L1-5
• • •
|
Lumbar Muscle Spasms
• • •
|
|
|
Mild, Moderate, Severe
|
|
Subluxation Pelvis
• • •
|
|
|
Subluxation Sacrum
• • •
|
Massage Pelvis and Hip Muscles Spasms
• • •
|
|
|
|
|
Extremity Subluxations
• • •
|
Massage Extremity Dysfunction
• • •
|
|
Extremity Subluxations Causing
• • •
|
Massage Extremity Muscles Spasms
• • •
|
|
|
Massage Extremity Causing
• • •
|
|
Subluxation Jaw
• • •
|
Jaw/Facial Muscles
• • •
|
|
|
|
|
Assessment of the patient today
• • •
|
Assessment of the patient today
• • •
|
|
% Improvement
• • •
|
% Improvement
• • •
|
|
Adjusting Techniques
• • •
|
Massage Techniques
• • •
|
|
Was treatment tolerated today?
|
Was treatment tolerated today?
|
|
|
|
|
Services Charged Today
• • •
|
Services Charged Today
• • •
|
|
New Patient Office Visit
|
For How Many Minutes
• • •
|
|
Report of Findings Office Visit
|
|
|
Reevaluation Office Visit
|
|
|
Office Visit (retake x-rays, review MRI)
|
|
|
Baby/Child Office Visit
|
|
|
|
|
|
Chiropractic Adjustments Performed
|
Massage Therapy Performed
|
|
Extremity Adjustment Performed
|
|
|
X-rays Taken Today
|
|
|
|
|
|
Manual Therapy
|
|
|
Muscles treated with Manual Therapy
• • •
|
|
|
Minutes
• • •
|
|
|
|
|
|
Therapeutic Exercises
|
|
|
Muscles treated with therapeutic exercise
• • •
|
|
|
Minutes
• • •
|
|
|
|
|
|
Manual Traction
|
|
|
Minutes
• • •
|
|
|
|
|
|
Neuromuscular Reeducation
|
|
|
Minutes
• • •
|
|
|
|
|
|
Follow up for next visit
• • •
|
Follow up for next visit
• • •
|
|
|
|
|
Prescriptions
• • •
|
Prescriptions
• • •
|
|
Using items prescribed?
• • •
|
Using items prescribed?
• • •
|
|
Recommendations
• • •
|
Recommendations
• • •
|
|
|
Massage Therapy Specific Modality Recommended
|
|
Referrals
• • •
|
Referrals
• • •
|
|
|
|
|
Home Instructions
• • •
|
Home Instructions
• • •
|
|
Treatment Schedule
• • •
|
Treatment Schedule
• • •
|
|
Normal Spine Free Draw
|
Massage Body Chart
|
|
Spinal Degeneration Free Draw
|
MLD Body Chart
|
|
MRI Disc Bulge/Herniation Free Draw
|
Therapist Comments/Precautions
|
|
Ankle Exercises
|
|
|
Chest Exercises
|
|
|
Elbow or Wrist Exercises
|
|
|
Hip Exercises
|
|
|
Knee Exercises
|
|
|
Lower Back Exercises
|
|
|
Neck Exercises
|
|
|
Shoulder Exercises
|
|
|
Upper Mid Back Exercises
|
|
