|
Subjective
|
Objective
|
|
Assessment
|
Plan
|
|
Chief Complaint
• • •
|
Chief Complaint Comments
|
|
CC status
|
CC Status Comments
|
|
% of day?
|
Quality of Pain Comments
|
|
Quality of pain
• • •
|
Function
• • •
|
|
|
Spinal Palpation Comments
|
|
Spinal Palpation
• • •
|
Cervical Subluxation Complex
• • •
|
|
Muscle Pain/Tenderness/Spasms
• • •
|
Thoracic Subluxation Complex
• • •
|
|
Gait
• • •
|
Lumbar Subluxation Complex
• • •
|
|
Range of motion
• • •
|
Sacrum Subluxation Complex
• • •
|
|
Posture Analysis
• • •
|
Pelvic Subluxation Complex
• • •
|
|
|
|
|
Occiput
• • •
|
|
|
C1
• • •
|
T1
• • •
|
|
C2
• • •
|
T2
• • •
|
|
C3
• • •
|
T3
• • •
|
|
C4
• • •
|
T4
• • •
|
|
C5
• • •
|
T5
• • •
|
|
C6
• • •
|
T6
• • •
|
|
C7
• • •
|
T7
• • •
|
|
L1
• • •
|
T8
• • •
|
|
L2
• • •
|
T9
• • •
|
|
L3
• • •
|
T10
• • •
|
|
L4
• • •
|
T11
• • •
|
|
L5
• • •
|
T12
• • •
|
|
Left Ilium
• • •
|
Right Ilium
• • •
|
|
Sacrum
• • •
|
Pelvis
• • •
|
|
Electrical Stim Unattended 97014
• • •
|
Treatment Frequency
• • •
|
|
Mechanical Traction 97012
• • •
|
Treatment Schedule
• • •
|
|
Hot Pack 97010
• • •
|
Chiropractic Adjustments 98942
• • •
|
|
Vibratory Massage 97124 59
• • •
|
Chiropractic Adjustments 98940
• • •
|
|
X-RAYS
• • •
|
Chiropractic Adjustments 98941
• • •
|
|
Plan-at home
• • •
|
Extraspinal Adjustments 98943
• • •
|
|
Ice
|
Plan- improving
• • •
|
|
Low Level Laser 97026
• • •
|
|
