|
Spinal Complaint #1
|
|
|
Spinal Complaint #1
|
|
|
Change in Pain Scale
|
Change in Pain
|
|
On a Scale of 1-10 (10 being the worst) how would you describe the pain?
|
The pain frequency is
|
|
How would you classify the pain?
|
The pain type is...
• • •
|
|
Does the pain radiate?
|
Has the radiation changed?
|
|
If Yes - Where does the pain radiate?
|
|
|
Any associated muscle spasms?
• • •
|
|
|
Spinal Complaint #2
|
|
|
Spinal Complaint #2
|
|
|
Change in Pain Scale
|
Change in Pain
|
|
On a Scale of 1-10 (10 being the worst) how would you describe the pain?
|
The pain frequency is
|
|
How would you classify the pain?
|
The pain type is...
• • •
|
|
Does the pain radiate?
|
Has the radiation changed?
|
|
If Yes - Where does the pain radiate?
|
|
|
Any associated muscle spasms?
• • •
|
|
|
Spinal Complaint #3
|
|
|
Spinal Complaint #3
|
|
|
Change in Pain Scale
|
Change in Pain
|
|
On a Scale of 1-10 (10 being the worst) how would you describe the pain?
|
The pain frequency is
|
|
How would you classify the pain?
|
The pain type is...
• • •
|
|
Does the pain radiate?
|
Has the radiation changed?
|
|
If Yes - Where does the pain radiate?
|
|
|
Any associated muscle spasms?
• • •
|
|
|
Extremity Complaint #1
|
|
|
Extremity Complaint #1
|
The pain is located on the
|
|
Change in Pain Scale
|
Change in Pain
|
|
On a Scale of 1-10 (10 being the worst) how would you describe the pain?
|
The pain frequency is
|
|
How would you classify the pain?
|
The pain type is...
• • •
|
|
Any associated muscle spasms?
• • •
|
|
|
Extremity Complaint #2
|
|
|
Extremity Complaint #2
|
The pain is located on the
|
|
Change in Pain Scale
|
Change in Pain
|
|
On a Scale of 1-10 (10 being the worst) how would you describe the pain?
|
The pain frequency is
|
|
How would you classify the pain?
|
The pain type is...
• • •
|
|
Any associated muscle spasms?
• • •
|
|
|
Other Complaint #1
|
|
|
Other Complaint #1
|
The pain is located on the
|
|
Change in Pain Scale
|
Change in Pain
|
|
On a Scale of 1-10 (10 being the worst) how would you describe the pain?
|
The pain frequency is
|
|
How would you classify the pain?
|
The pain type is...
• • •
|
|
Any associated muscle spasms?
• • •
|
|
|
|
|
|
Additional Comments
|
|
