|
History/Subjective:
|
History by Dr. Porter
|
|
Area of primary pain
• • •
|
Location
|
|
Other areas of pain
• • •
|
Location
|
|
Onset
|
Date of Onset
|
|
Mechanism of Injury
|
Palliative
• • •
|
|
Provocative
• • •
|
tingling/numbness
• • •
|
|
Denies Numbness/Tingling
|
VAS
|
|
Nature of Pain
• • •
|
Other Doctors
• • •
|
|
No other care before toay.
|
History of Illness
|
|
Frequency
|
Timing
• • •
|
|
Night sweats / Weight Loss / bowel or bladder
|
Sleep
|
|
Improved Yes / No
|
Prior chiropractic care
|
|
Spanish
|
|
