|
Subjective
|
|
|
History
|
Pain at worst
/
|
|
Pain at Best:
/
|
Increased Pain
• • •
|
|
Type of Pain
• • •
|
|
|
Objective
|
Review of Systems
|
|
Radiating Pain
• • •
|
|
|
Posture
• • •
|
Myo/Derm WNL
|
|
Deformities
• • •
|
Dermatomes
• • •
|
|
Myotomes
• • •
|
|
|
Repeated Flexion
• • •
|
Repeated Extension
• • •
|
|
Repeated Right side glide
• • •
|
Repeated Left side glide
• • •
|
|
Special Tests
• • •
|
Other Objective Findings
|
|
Assessment
|
Rehab Potential
• • •
|
|
Goal 1
|
Goal 2
|
|
Goal 3
|
Goal 4
|
|
Plan
|
Treatment Plan
|
|
Treatment Duration
• • •
|
Treatment Frequency
• • •
|
|
Today's STM
• • •
|
|
|
Manual Therapy
|
Self Care/ pain management
|
|
Exercises
|
HEP
|
