Low Back Pain/Injury History

Injury & Poisoning, Musculoskeletal & Rheumatology, Subjective/History Elements
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Low Back Pain/Injury
Onset [text] prior to evaluation
Onset while: [text]
Injury at: [text]

Associated Pain (0=none, 10=severe)
Location: [text]
Radiation: [text]
Severity now (0-10): [text]
Severity at worst (0-10): [text]
Duration: [text]
Characterized as [text].

Relieved with [text]
Worse with [text]
[select value="no|YES"] <-- worse with cough

Pitfall evaluation:
[select value="no|YES"] <-- fever
[select value="no|YES"] <-- hematuria
[select value="no|YES"] <-- inner thigh numbness
[select value="no|YES"] <-- foot drop
[select value="no|YES"] <-- urine retention or incontinence
[select value="no|YES"] <-- stool retention or incontinence

[select value="no|YES"] <-- prior back pain history with last episode [text]
[select value="no|YES"] <-- intervertebral disc injury
[select value="no|YES"] <-- spine surgery history

[select value="no|YES"] <-- compression fracture or osteoporosis history
[select value="no|YES"] <-- nephrolithiasis history
[select value="no|YES"] <-- peptic ulcer disease history
[select value="no|YES"] <-- aortic aneurysm history or risk (age over 60, tobacco history)
[html]<hr>[/html][checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"][html]
reference: contributed by Dr. Scott Moses, creator/author of the <a href="http://www.fpnotebook.com" target="_blank">Family Practice Notebook</a>.[/html][/conditional]
Low Back Pain/Injury
Onset prior to evaluation
Onset while:
Injury at:

Associated Pain (0=none, 10=severe)
Location:
Radiation:
Severity now (0-10):
Severity at worst (0-10):
Duration:
Characterized as .

Relieved with
Worse with
<-- worse with cough

Pitfall evaluation:
<-- fever
<-- hematuria
<-- inner thigh numbness
<-- foot drop
<-- urine retention or incontinence
<-- stool retention or incontinence

<-- prior back pain history with last episode
<-- intervertebral disc injury
<-- spine surgery history

<-- compression fracture or osteoporosis history
<-- nephrolithiasis history
<-- peptic ulcer disease history
<-- aortic aneurysm history or risk (age over 60, tobacco history)

display/hide references
Result - Copy and paste this output:

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