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Re-Eval
|
|
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C/C
• • •
|
Overall SBW
|
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Unchanged Neuro
|
|
|
ROM?
|
|
|
C/S ROM
|
ROMs Increase/Decrease
|
|
T/S ROM
|
ROMs Increased/Decreased
|
|
L/S ROM
|
L/S AROMs Increased/Decreased
• • •
|
|
Shoulder AROMs
|
SH ROMs Increased/Decreased
|
|
KN AROMS
|
KN ROMs Increased/Decreased
|
|
|
|
|
Ortho Exam
|
|
|
C/S Ortho
|
Positive Tests (C/S)
• • •
|
|
T/S Ortho
|
T/S Positive Ortho
• • •
|
|
L/S Ortho
|
L/S Positive Ortho
• • •
|
|
SI/Pelvis Ortho
|
SI Positive Ortho
• • •
|
|
Shoulder Ortho
|
Shoulder Positive Ortho
• • •
|
|
KN Ortho
|
KN Positive Ortho
• • •
|
|
|
|
|
No Change Dx
|
|
|
|
|
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Treatment Modalities
• • •
|
|
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Frequency
|
Duration (weeks)
|
|
Goals
|
Referral
|
|
Today's Visit/Modalities
• • •
|
|
