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10. Sample YES adjusting - Technique Adjusting Notes Upper...

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Unformatted text preview: Technique Adjusting Notes Upper Cervical Specific "Toggle" Patient Name: ‘\\\ SMI‘I“ Case#: LOSIQ3L/ Patient Signature; 2 , Doctor’s Name: (getcredit for sheet) 5 A ID in c ‘ Seat number—‘37 Class hour 932.5 Atlas: MP— Axis: ‘ +1340, {Sf-#6 FacultyApproval % Faculty Approval to Adjust: Si - nature/ Initials: ’7 Faculty RevieWed Non-adjusting Scans: S nature/Initials- Date: Date: 5 l‘ 28' O Fossa: — Fossa: —'3’fl__ Leg Check: " Leg Check: LUV I E l O Palpation: Palpation: ( B I Home ' Reshncl-rc‘ lr-{ll‘ L41” Bfnéw‘g' Symptomatolgy: A) Symptomatolgy: 0h 6, M On 2 Copyright Gindl, et al, May, 2005 Date: Pattern: Full Fossa (Pre): ‘ - Fossa (Post): Leg (Pre): (”fl Leg Check (Post): ‘ Palpation (Pre) Eds-true c 066. Ta Lde, Symptomatolgy (Pre): N one, Symptomatolgy (Post): Faculty: Student Doctor: (Student doctor adjusting & all students must sign at least one) Date: Q’L/"OEZ Pattern: Full Partial X Adpt Fossa (Pre): ' 80 7?. Fossa (Post): ~30 R. Leg (Pre): L+ ’[2 H Leg Check (Post): cued Palpation (Pre) +2 060% l / .Ql Symptomatolgy (Pre): N O ne Symptomatolgy (Post): U m 6 racuqulmfilmb Student WWW (Student doctor ad usting & a ud must sign at least one) Date: 5" 5‘0 3 Pattern: Full Partial Adpt A Fossa (Pre): ' i (3 Q ' Fossa (Post): Leg (Pre): 8 Dad LegCheck (Post): Palpation (Pre) M 0A6. Symptomatolgy (Pre): [U an e, Symptomatolgy (Post): Faculty: Student Doctor: %i g 2% . (Student doctor adju mg & a ud ts must sign at least one) ...
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