|
Subjective
|
Time
|
|
HISTORY
|
P worst
• • •
|
|
INCREASED PAIN WITH
|
P Best
• • •
|
|
|
|
|
Body Diagram
|
|
|
Objective
|
EDEMA
• • •
|
|
ROM Knee flexion LEFT
|
Knee flexion RIGHT
|
|
Knee extension LEFT
|
Knee extension RIGHT
|
|
Hip extension LEFT
|
Hip extension RIGHT
|
|
Ankle DF LEFT
|
Ankle DF RIGHT
|
|
Straight leg raise LEFT
|
Straight leg raise RIGHT
|
|
Tibial IR
• • •
|
|
|
Hamstring Left
• • •
|
Right Hamstring
• • •
|
|
L Quads
• • •
|
R Quads
• • •
|
|
L Glutes
• • •
|
R Glutes
• • •
|
|
L Glute Med
• • •
|
R Glute Med
• • •
|
|
Heel raises LEFT
/
|
Heel raises RIGHT
/
|
|
DL Squat
• • •
|
SL Squat
• • •
|
|
PALPATION
|
TEST: Balance
|
|
TEST: Patellar compression
|
Test Ligaments
• • •
|
|
Meniscus
• • •
|
TEST: Ligaments
|
|
Objective Notes
|
|
|
|
|
|
Assessment:
|
PROBLEM 1
|
|
PROBLEM 2
|
PROBLEM 3
|
|
PROBLEM 4
|
PROBLEM 5
|
|
GOAL 1
|
GOAL 2
|
|
GOAL 3
|
GOAL 4
|
|
GOAL 5
|
Rehab Potential
|
|
Plan
|
|
|
Treatment Frequency
• • •
|
Treatment Duration
• • •
|
|
Treatment Plan
|
Patient Education
• • •
|
|
Additional Plan instructions/notes:
|
|
|
|
|
|
Today's Treatment
|
|
|
Manual therapy
• • •
|
Joint Mobs
• • •
|
|
Other manual
|
|
|
Exercises
|
HEP
|
|
MD Signature
|
|
