|
SUBJECTIVE
|
|
|
History of Present Illness/Chief Complaint
|
|
|
Current Complains
|
|
|
Pain frequency
• • •
|
|
|
Neck/Upperback pain rating
|
|
|
Remarks
|
|
|
Shoulder pain rating
|
|
|
Remarks
|
|
|
Past Medical History
|
|
|
Stage of condition
|
Cause of current episode
|
|
Nature of condition
|
|
|
VITAL SIGNS
|
|
|
Weight
|
Height
|
|
Blood pressure
|
|
|
OBJECTIVE
|
|
|
Inspection
|
|
|
Palpation
|
|
|
|
|
|
SPINAL SYMPTOM RATING
|
|
|
Disability Index
|
Result
|
|
ORTHOPEDIC TESTS
|
|
|
Spurling's Test
|
Note
|
|
Cervical Distraction Test
|
Note
|
|
Bakody's sign
|
Note
|
|
Impingement Sign
|
Note
|
|
Speed's Test
|
Note
|
|
Empty Can Test
|
Note
|
|
Spinal Percussion - Result
|
Note
|
|
Range of Motion
|
|
|
Cervical Extension - Active
|
|
|
Cervical Flexion - Active
|
|
|
Left Cervical Rotation - Active
|
|
|
Right Cervical Rotation - Active
|
|
|
Right Lateral Flexors
|
|
|
Left Cervical Rotation - Active
|
|
|
Shoulder Flexion - Active
|
Note
|
|
Shoulder Extension - Active
|
Note
|
|
MUSCLE STRENGTH
|
|
|
Cervical Flexors
|
|
|
Cervical Extensors
|
|
|
Right Cervical Rotators
|
|
|
Left Cervical Rotators
|
|
|
Right Lateral Flexors
|
|
|
Left Lateral Flexors
|
|
|
ASSESSMENT
|
|
|
|
|
|
Plan of Care
|
|
|
OFFICE NEW LOW 30 MIN: (99203)
|
Rationale for manual therapy
|
|
CHIROPRACT MANJ 3-4 REGIONS : (98941)
|
Rationale for manual therapy
|
|
CHIROPRACT MANJ 1-2 REGIONS : (98940)
|
Rationale for manual therapy
|
|
CHIROPRACT MANJ XTRSPINL 1/> : (98943)
|
Rationale for manual therapy
|
|
MECHANICAL TRACTION THERAPY : (97012)
|
Rationale for manual therapy
|
|
Therapeutic Exercise: (97110)
|
Rationale for manual therapy
|
|
Electric Stimulation : (G0283)
|
Rationale for the procedure
|
|
Electric Stimulation : (97014)
|
Rationale for the procedure
|
|
Manual Therapy: (97140)
|
Rationale for manual therapy
|
|
Short term goals
|
|
|
Long term goals
|
|
