|
Subjective
|
|
|
History
|
Pain at worst
/
|
|
Pain at best
/
|
Increased Pain
• • •
|
|
Type of pain
• • •
|
|
|
Objective
|
Review of Systems
|
|
Radiating Pain
• • •
|
Myo/Derm WNL
|
|
Posture/Deformities
• • •
|
Dermatomes
• • •
|
|
Myotomes
• • •
|
Repeated Motions
• • •
|
|
Radiculopathy Special Tests
• • •
|
Cervical Instability Tests
• • •
|
|
Cervical Myelopathy Screening
• • •
|
Thoracic Outlet Syndrome Tests
• • •
|
|
Cervicogenic Headaches Tests
• • •
|
Facet Joint Dysfunction
• • •
|
|
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
|
|
