ANLS 1618 LC1000 Full Spine

ANLS 1618 LC1000 Full Spine - Date: _/_/_ _ Patient Name: _...

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Date: ____/____/____ Patient Name: _____________________________________________ #: ____________ Visit #: ______ Intern Name (print): ________________________________________ #: ____________ SUBJECTIVE 1. Patient condition appraisal (1 - worst 10 - best) 1 2 3 4 5 6 7 8 9 10 CLINIC LEVEL 2. Any new injuries, accidents, falls, blows or trauma since last visit? Yes No 3. Is there any change in your chief complaint? Yes No 4. Any new complaints with how you feel since your last visit? Yes No 5. Have you seen any other healthcare provider since your last visit? Yes No Full Spine If yes explain: DC Init: Patient Signature: Date: OBJECTIVE Chiropractic Analysis Cervical Thoracic Lumbar Pelvis mark O 1 2 3 4 5 6 7 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 S RI LI Instrumentation X Digital Palpation X Motion Restriction F/E X Motion Restriction Rot R/L Motion Restriction LF R/L Subluxations X Adjustments X Listings from Above: mark O 1 2 3 4 5 6 7 1 2 3 4 5 6 7 8 9 10
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This note was uploaded on 11/21/2011 for the course ANLS 1618 taught by Professor Laurahuber during the Winter '11 term at Life Chiropractic College West.

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ANLS 1618 LC1000 Full Spine - Date: _/_/_ _ Patient Name: _...

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