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New Patient/New Condition
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Follow-Up
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Pre-Op
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MRI Review
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Pre-Op Fields
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Surgical Side
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Surgical Procedure (free type)
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Date of Surgery
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Surgery Location
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Reference Field
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MRI Review Fields
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Telemedicine
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Side
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Imaging Type
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Imaging Location
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Imaging Location (free-text)
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Date of Service
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Conditions Being Evaluated
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Availability of Images/Report
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HPI
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HPI
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Location of pain
• • •
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Radiating pain location
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Numbness/tingling location
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Pain score (0-10)
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Positive symptoms
• • •
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Negative symptoms
• • •
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Denies previous injury or treatment
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Bilateral
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HPI
|
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Location of pain
• • •
|
Radiating pain location
|
|
Numbness/tingling location
|
Pain score (0-10)
|
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Positive symptoms
• • •
|
Negative symptoms
• • •
|
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Medication
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Denies medication
|
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Work Status
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Additional information
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