CLIN 2504 Chiropractic and Screening Physical Exams

CLIN 2504 Chiropractic and Screening Physical Exams -...

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Unformatted text preview: Chiropractic and Screening Physical Exam Form: RPF-3000 Version 3.1 Revised Oct 06, 2005 TG/se Page 1 of 6 2005 Life University College of Chiropractic College of Chiropractic Clinics Exam Number: c d e f g h i j k ____ Name Date File # Blood Pressure: Left Right DOB Age Height Weight Pulse Resp Temp LEG LENGTH Prone: Supine: INSTRUMENTATION POSTURE L NORM R Head Tilt Head Rotation Head Translation Ant Post High Shoulder Rib Humping Thoracic Kyphosis Hypo Hyper High Ilium Knees Varus Knees Valgus Ext Rot Foot Int Rot Foot Foot Pronation Foot Supination INSPECTION NOTES 1. Gait Normal Irregular 2. Ambulation Normal Irregular Chiropractic and Screening Physical Exams Page 2 Form: RPF-3000 Version 3.1 Revised Oct 06, 2005 TG/se Page 2 of 6 2005 Life University College of Chiropracitc CERVICAL ROM ACTIVE ROM PASSIVE ROM NORM DEGREES PAIN NORM DEGREES PAIN 1. Flexion ## No Yes ## No Yes 2. Extension ## No Yes ## No Yes 3. Right Rotation ## No Yes ## No Yes 4. Left Rotation ## No Yes ## No Yes 5. Right Lateral Flexion ## No Yes ## No Yes 6. Left Lateral Flexion ## No Yes ## No Yes NOTES CERVICAL TESTS NOTES 1. Soto-Hall Negative Positive 2. Valsalvas Negative Positive 3. Foramina Compression Negative Positive 4. Cervical Distraction Negative Positive 5. Allens Negative Positive 6. Vertebrobasilar Negative Positive 7. Adsons Negative Positive 8. Bakodys Negative Positive 9. Shoulder Depressor Negative Positive LUMBAR ROM ACTIVE ROM PASSIVE ROM NORM...
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CLIN 2504 Chiropractic and Screening Physical Exams -...

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