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General
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Orientation
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HEENT WNL
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HEENT Comments
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Neck WNL
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Neck Comments
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Cardiovascular WNL
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Cardiovascular Abnormal
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Cardiovascular Comments
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Lungs WNL
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Lungs Abnormal
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Lungs Comments
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Abdomen Comments
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MSK Comments
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Extremities WNL
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Extrem Abnormal
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Language
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Speech
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Cranial Nerve II
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Cranial Nerves III, IV, VI
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Cranial Nerve V
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Cranial Nerve VII
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Cranial Nerve VIII
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Cranial Nerve IX,X
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Cranial Nerve XI
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Cranial XII
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Motor Exam
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Motor Tone
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Detailed Motor Exam
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Upper Extremities
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Right Deltoid
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Left Deltoid
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Right Biceps
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Left Biceps
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Right Triceps
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Left Triceps
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Right Wrist Extensors
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Left Wrist Extensors
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Right Wrist Flexors
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Left Wrist Flexors
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Right Finger Extensors
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Left Finger Extensors
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Right Finger Flexors
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Left Finger Flexors
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Right Finger Interossei
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Left Finger Interossei
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Wasting seen :
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Other Comments
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Lower Extremities
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Right Iliopsoas
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Left Iliopsoas
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Right Quadriceps
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Left Quadriceps
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Right Hamstrings
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Left Hamstring
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Right Adductors
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Left Adductors
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Right Abductors
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Left Abductors
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Right Tibialis Anterior
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Left Tibialis Anterior
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Right Dorsiflexors
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Left Dorsiflexors
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Right Gastroc
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Left Gastroc
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Right EHL
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Left EHL
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Other Comments
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Abnormal Motor Exam
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Involuntary movements
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Extremity Ataxia
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Ataxia/Movement Comments
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Movement comments
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Sensation
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Sensation Comment
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Gait
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Gait Comments
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Reflexes
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Reflex comments
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Is patient over 65 years of age? if so, complete fall risk.
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Prior to last fall, how much assistance for ADLs?
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How many falls in the last 12 months?
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Total score from risk assessment
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When walking or turning ...
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