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Chief Complaint
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TCM Diagnosis/ Impression
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Better Same Worse
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Meridians
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Last 24hrs pain intensity
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Assessment
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Pain past week
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Functional Status
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Pain Characteristic
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Functional Status 2
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Location of Radiation
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1ST Treatment Plan
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Frequency of Pain
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Point location
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ADL's
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2nd Treatment Plan
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Right Pulse location
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Point location
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Left Pulse location
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3rd Treatment Plan
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Right Pulse Quality
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Point location
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Left Pulse Quality
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4th Treatment Plan
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Right Pulse Frequency
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Point location
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Left Pulse Frequency
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Ass-responding
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Tongue Coating
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Re-Eval & Change Visits?
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Tongue Shape
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Patient Instruction
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Tongue Color
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ROM
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ROM Restricted In?
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2nd ROM
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Restricted In?
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Extremity ROM
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Extremity Assessment
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Cervical examination
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Cervical Muscle
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Cervical side
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Thoracic examination
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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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