Chiropractic Exam- S Part

Chiropractic [select name="variable_1" value="Initial Exam|Re-Evaluation"]

History:
Today [date name="variable_2" default="04-04-2023"], [text name="variable_3" default=],presents with a [select name="variable_4" value="initial iteration|exacerbation|Re-Exacerbation"], of [checkbox name="location" value="Local Lower Back Pain|Radiating Lower Back Pain| Local Mid Back Pain|Local Neck Pain|Radiating Neck Pain|Other"] that occured [select name="Dates" value="Today|yesterday|a week ago|2 weeks ago|3 weeks ago| a month ago|a year ago"]

Describe Other:[textarea name="variable_6" default=]

Subjective:

[text name="variable_3" default=] describes their pain as [checkbox name="quality" value="Sharp,Stabbing|Dull and Achy|Stiff and Achy|Burning"], they rate their pain as a [checkbox name="VAS" value="1|2|3|4|5|6|7|8|9|10"] out of 10 at its worst. 
They state that [checkbox name="Palliative" value="stretching|exercising|walking|OTC medication|Ice|Heat|resting"] makes it better. 
They state that [checkbox name="provocative" value="walking|sitting for long periods of time|standing for long periods of time|laying down|getting up from sitting to standing|Changing Positions at night|Coughing|Sneezing|Going to the bathroom|any movement of the affected area"] makes it worse. 
They state that they have [select name="hadnot" value="had|have not"] had this type of pain before. 

They state the mechanism of injury as follows : [textarea name="MOI" default=]. 

They [select name="YN" value="Have sought out care before|have not sought out care before"] for this issue.

They state that activities of daily living are [select name="ADLS" value="Severely|Moderately|Slightly"] affected