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Chief Complaint
• • •
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Chief Complaints
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Location
• • •
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Location
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Onset/Timing
• • •
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Onset/Timing
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Quality, Description
• • •
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Quality, Description
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Severity
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Severity
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Last 24hrs pain intensity
• • •
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Context Comments
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Pain past week
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Modifying Factors Comments
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Symptoms
• • •
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Associated Symptoms Comments
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Context
• • •
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Associated Symptoms
• • •
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Traveling To?
• • •
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What makes it Better?
• • •
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What makes it worse?
• • •
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Frequency of Pain
• • •
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ADL
• • •
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Oswestry Low Back Pain Disability Index
• • •
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Section 1 – Pain intensity
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Section 2 – Personal care (washing‚ dressing etc)
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Section 3 – Lifting
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Section 4 – Walking
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Section 5 – Sitting
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Section 6 – Standing
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Section 7 – Sleeping
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Section 8 – Sex life (if applicable)
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Section 9 – Social life
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Section 10 – Travelling
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Oswestry Neck Disability Index
• • •
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Oswesty scores Interpretation
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DASH Score
• • •
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Previous Treatment
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LEFS Index
• • •
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