14. Blank Toggle Adjusting Form

14. Blank Toggle Adjusting Form - Technique Adjusting Notes...

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Unformatted text preview: Technique Adjusting Notes Upper Cervical Specific "Toggle" Patient Name: Case #: Patient Signature: Doctor’s Name: (get credit for sheet) Seat number Atlas: Class hour Faculty Approval_________________ Axis: Practice films check here: Listing to be adjusted (circle): ASSESSMENT: Visualization: Cervical: Head tilt L R None Head rotation L R None Thoracic: High Shoulder L R None Special Instructions (Contraindications, cautions, or other significant history): NAD FACULTY NOTES: Faculty Approval to Adjust: Signature/Initials: Faculty Reviewed Non-adjusting Scans: Signature/Initials: Patient Workup (establish pattern): Date: Date: Fossa: Fossa: Leg Check: Leg Check: Palpation: Palpation: Symptomatolgy: Symptomatolgy: Copyright Gindl, et al, May, 2005 Patient Workup and Adjustment: Date: ________________________ Pattern: Full______Partial______Adpt____ Fossa (Pre): __________________ Fossa (Post): __________________ Leg (Pre): ____________________ Leg Check (Post): ______________ Palpation (Pre)______________________________________________________ Symptomatolgy (Pre): Symptomatolgy (Post): Faculty:____________________ Student Doctor:_________________________ (Student doctor adjusting & all students must sign at least one) Date: ________________________ Pattern: Full______Partial______Adpt____ Fossa (Pre): __________________ Fossa (Post): __________________ Leg (Pre): ____________________ Leg Check (Post): ______________ Palpation (Pre)______________________________________________________ Symptomatolgy (Pre): Symptomatolgy (Post): Faculty:____________________ Student Doctor:_________________________ (Student doctor adjusting & all students must sign at least one) Date: ________________________ Pattern: Full______Partial______Adpt____ Fossa (Pre): __________________ Fossa (Post): __________________ Leg (Pre): ____________________ Leg Check (Post): ______________ Palpation (Pre)______________________________________________________ Symptomatolgy (Pre): Symptomatolgy (Post): Faculty:____________________ Student Doctor:_________________________ (Student doctor adjusting & all students must sign at least one) ...
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This note was uploaded on 01/07/2012 for the course TECHNIQUE 62603 taught by Professor Bhogal during the Winter '11 term at Palmer Chiropractic.

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