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S(SUBJECTIVE)
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HISTORY:
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# of visit
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#1st complaint Quality of the pain:
• • •
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Chief Complaint: Patient complains of pain in LOCATION?
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better or worse since last visit?
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Pain Sclae
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ADL Change better
• • •
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Current Functional Deficit
• • •
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Deficit Time
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#2nd complaint Quality of the pain:
• • •
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2nd Complaint: Patient complains of pain in LOCATION?
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better or worse since last visit?
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Pain Sclae
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ADL Change better
• • •
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Current Functional Deficit
• • •
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Deficit Time
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Objective:
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Musculoskeletal
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- Inspection/Percussion +/or Palpation: l
• • •
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Spinal/Extraspinal Restriction(s)/Subluxation(s)
• • •
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ROM Concern(s):
• • •
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A(ASSESSMENT)
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Daily Assessment:
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DIAGNOSIS:
• • •
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PLAN
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- Chief Complaint Short Term Tx Goal:
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- 2nd Complaint Short Term Tx Goal:
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97813
• • •
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97814
• • •
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97811
• • •
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97811
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Statement
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