|
Chief Complaint
• • •
|
Chief Complaint - weakness
• • •
|
|
Last 24hrs pain intensity
• • •
|
Frequency of Difficulty
• • •
|
|
Pain past week
• • •
|
ROM - weakness
• • •
|
|
Better Same Worse
• • •
|
ROM Restricted In? - weakness
• • •
|
|
Pain Characteristic
• • •
|
2nd ROM - weakness
• • •
|
|
Frequency of Pain
• • •
|
Restricted In? - 2 weakness
• • •
|
|
Location of Radiation
• • •
|
Extremity ROM
• • •
|
|
Duration
• • •
|
Restricted In? - 3 weakness
• • •
|
|
|
|
|
ROM
• • •
|
Limitation in ADL's due to weakness
• • •
|
|
ROM Restricted In?
• • •
|
Assessment
• • •
|
|
2nd ROM
• • •
|
Functional Status
• • •
|
|
Restricted In?
• • •
|
Functional Status 2
• • •
|
|
Extremity ROM
• • •
|
% Improvement
• • •
|
|
Extremity Assessment
• • •
|
Ass-responding
• • •
|
|
Cervical examination
• • •
|
Plan
• • •
|
|
Cervical Muscle
• • •
|
Modalities used
• • •
|
|
Cervical side
• • •
|
Patient Exercises Given
• • •
|
|
Thoracic examination
• • •
|
Patient Instruction
• • •
|
|
Thoracic Muscle
• • •
|
Modalities
• • •
|
|
Thoracic side
• • •
|
|
|
Lumbar examination
• • •
|
|
|
Lumbar Muscle
• • •
|
|
|
Lumbar side
• • •
|
|
|
Sacrum examination
• • •
|
|
|
Sacrum muscle
• • •
|
|
|
Sacrum side
• • •
|
|
|
Trigger Points Palpated
• • •
|
|
|
Assessment
• • •
|
|
|
ADL's
• • •
|
|
|
Functional Status
• • •
|
|
|
Functional Status 2
• • •
|
|
|
% Improvement
• • •
|
|
|
Ass-responding
• • •
|
|
|
Plan
• • •
|
|
|
Continue current visit plan
|
|
|
Re-Eval & Change Visits?
• • •
|
|
|
1 Unit TherEx
|
|
|
2 Units TherEx
|
|
|
1 Manual Therapy
|
|
|
2 Manual Therapy
|
|
|
1 Unit NeuroMuscular Education
|
|
|
2 Unit NeuroMuscular Education
|
|
|
1 Unit - Therapeutic activities (97530)
|
|
|
2 Unit - Therapeutic activities (97530)
|
|
|
3 Unit - Therapeutic activities (97530)
|
|
|
Therapeutic Activities - (U/E & neck)
• • •
|
|
|
Therapeutic Activities - (L/E & Lower back)
• • •
|
|
|
Exercises given
• • •
|
|
|
Exercise - Neck
• • •
|
|
|
Exercise - Lower back
• • •
|
|
|
Exercise - Shoulder
• • •
|
|
|
Exercise - Elbow
• • •
|
|
|
Exercise - Wrist & Hand
• • •
|
|
|
Exercise - Hip
• • •
|
|
|
Exercise - Knee
• • •
|
|
|
Exercise - Ankle & Foot
• • •
|
|
|
Patient Instruction
• • •
|
|
