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Chief Complaint
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Chief Complaint - weakness
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Last 24hrs pain intensity
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Frequency of Difficulty
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Pain past week
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ROM - weakness
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Better Same Worse
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ROM Restricted In? - weakness
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Pain Characteristic
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2nd ROM - weakness
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Frequency of Pain
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Restricted In? - 2 weakness
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Location of Radiation
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Extremity ROM
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Duration
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Restricted In? - 3 weakness
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ROM
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Limitation in ADL's due to weakness
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ROM Restricted In?
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Assessment
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2nd ROM
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Functional Status
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Restricted In?
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Functional Status 2
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Extremity ROM
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% Improvement
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Extremity Assessment
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Ass-responding
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Cervical examination
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Plan
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Cervical Muscle
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Modalities used
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Cervical side
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Patient Exercises Given
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Thoracic examination
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Patient Instruction
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Thoracic Muscle
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Thoracic side
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Lumbar examination
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Lumbar Muscle
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Lumbar side
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Sacrum examination
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Sacrum muscle
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Sacrum side
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Trigger Points Palpated
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Assessment
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ADL's
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Functional Status
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Functional Status 2
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Ass-responding
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Plan
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Continue current visit plan
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2 Units TherEx
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1 Unit TherEx
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1 Unit NeuroMuscular Education
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2 Manual Therapy
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1 Unit - Therapeutic activities (97530)
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2 Unit NeuroMuscular Education
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1Unit - Self Care Management Training (97535)
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1 Manual Therapy
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Patient Exercises Given
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Exercise - Neck
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Exercise - Lower back
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Exercise - Shoulder
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Exercise - Elbow
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Exercise - Wrist & Hand
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Exercise - Hip
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Exercise - Knee
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Exercise - Ankle & Foot
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Patient Instruction
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