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Chief Complaint
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Body Diagram
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Change
• • •
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Comments
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Pain Rating
• • •
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Hot Stone
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Type of Pain
• • •
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Treatment Intention
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Comments
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Techniques used
• • •
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Comments
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ROM
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Areas Treated
• • •
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Comments
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Trigger Points
• • •
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Comments
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Referral Recommendations
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Kinesiology Tape
• • •
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Notes for Next Visit
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Homecare Recommendations
• • •
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