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New Patient
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Return Patient
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Chief Complaint
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Present Medical
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Chief Complaint Other
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Medical Conditions Other
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Fibromyalgia
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History PAIN
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Cranio Facial Pain CC
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Pain Quality
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Frequency
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Pain Scale
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CC Timing
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Sleep Quality
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Status
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Comments
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Normal Upper Extremity Exam
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Motor Exam Normal
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Normal Lower Extremity Exam
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Neck / Spine Normal
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Neck and Spine Comments
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Back / Spine Normal
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Back and Spine Comments
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Vision ROS
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Psych/Emotional ROS
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ENT ROS
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Illnesses ROS
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Cardio-Pulmonary ROS
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Habits ROS
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Gastrointestinal ROS
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Hematologic/Immunologic ROS
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Endocrine ROS
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Genitourinary ROS
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Neurological ROS
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GYN ROS
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Musculoskeletal ROS
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Stress ROS
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Dermatological ROS
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Dental ROS
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Sensory Exam RUE
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Sensory Exam LUE
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Sensory Exam RLE
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Sensory Exam LLE
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Right Hand and Wrist Exam
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Left Hand and Wrist Exam
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Right Elbow Exam
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Left Elbow Exam
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Right Shoulder Exam
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Left Shoulder Exam
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Right Hip Exam
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Left Hip Exam
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Right Pelvic Exam
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Left Pelvic Exam
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Right Knee Exam
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Left Knee Exam
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Right Ankle Exam
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Left Ankle Exam
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Right Foot Exam
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Left Foot Exam
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Manual Therapy PRT Brief
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Psoas Hypertonicity
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Manual Therapy PRT Full
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Piriformis
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Spinal Segments [+]
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Abnormal Myotome [+]
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Posture Analysis [+]
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Cervical Rot IMS
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Motor Points [+]
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Cervical Flex IMS
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Positive ORTHO Tests
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Cervical SB IMS
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Assessment Dialogue
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INMAS Supine
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INMAS Prone
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Neuroanatomical Acupuncture
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Acupuncture NMT
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Laser Therapy
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Kinesio Tape
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Lab Orders
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Treatment Care Phase
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Pain Management ICD-9
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Plan: General Rehab Instructions
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PLAN: Other Specific Orders
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Goals of Treatment
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Total Time Spent
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Follow-up
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Sig/Medical Authorization
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Medical Acupuncture
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