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Subjective
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Is this a maintenance care visit?
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How are you feeling since your last visit?
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Rate Your Pain (1-10)
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What quality is your pain like?
• • •
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What Increases Your Pain?
• • •
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What do you feel is helping?
• • •
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What % is your condition improved overall?
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What % of the day do you feel symptoms?
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Type Any Other Changes/Comments:
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New Free Draw
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