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Subjective
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Chief Complaint:
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History of Present Illness (HPI)
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Current Complaint:
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Past Medical History
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ADL Limitations:
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Objective:
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Inspection:
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Palpation:
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Motion Palpation:
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Range of Motion:
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Cervical:
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Lumbar:
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Note:
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Thoracic
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Extremity ROM:
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Shoulder
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Hip
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Note:
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Orthopedic Testing:
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Cervical / Upper Extremity
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Lumbar / Hip Orthopedic Tests
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Thoracic Orthopedic Tests
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Muscle Strength
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Cervical / Upper Extremity
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Lumbar / Lower Extremity
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Diagnostic Imaging / X-Ray Results
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Assessment
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Dx:
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Clinical Impression
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Outcome Measure:
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Short Term Goal (4 Weeks)
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Long Term Goal (6-12 Weeks)
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Plan of Care
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Treatment Today
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99203 – OFFICE O/P NEW LOW 30 MIN
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99213 – OFFICE O/P EST LOW 20 MIN
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98940 – CHIROPRACT MANJ 1-2 REGIONS
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98943 – CHIROPRACT MANJ XTRSPINL 1/>
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97012 – MECHANICAL TRACTION THERAPY
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97110 – THERAPEUTIC EXERCISES
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97140 – MANUAL THERAPY 1/> REGIONS
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97530 – THERAPEUTIC ACTIVITIES
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97535 – SELF CARE MNGMENT TRAINING
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G0283 – Elec stim other than wound
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97032 – APPL MODALITY 1+ESTIM EA 15
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72040 – X-RAY EXAM NECK SPINE 2-3 VW
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72100 – X-RAY EXAM L-S SPINE 2/3 VWS
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Billing & Time Summary
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