RMP WC Back Pain

Last Name: [text name="last_name"]    First Name: [text name="first_name"]    
Age: [text name="age"]    Pronoun: [text name="he_she" default="he/she"]    
Job Title: [text name="job_title"]
Start Date: [text name="start_date" ]    Department/Location: [text name="job_location"]    Employer: [text name="employer_name"]

[comment memo="recommended follow-up for own medical conditions, not related to return to work" memo_size="small" memo_color="blue"]
[select name="other_conditions_identified" value="|Other conditions in need of follow-up care are identified."]
Things to review with your doctor: [textarea name="recommended_follow_up" default=""][/textarea]



====================================

Introduction

[var name="first_name"] [var name="last_name"] is a [var name="age"] year old [var name="job_title"] working in/at [var name="job_location"], since hired by [var name="employer_name"] on [var name="start_date"]. [var name="first_name"] [select name="is_working" value="is currently working.|is currently not working."] [textarea name="currently_working_info"][/textarea] 

Description of Injury
[textarea name="description_of_injury"]
Occurred on 
Worked remainder of shift? 
ED Evaluation?

Treatment thus far has included 
[/textarea]

Description of Current Symptoms
[textarea name="description_of_current_symptoms"]
At this moment, employee reports 

Is this better or worse than immediately after the injury

Denies weakness, paresthesias, dysesthesias, incontinence, falls 
[/textarea]

Relevant Past Medical History
[textarea name="past_medical_history"]
Prior history of back problems? 


[/textarea]


Other Medications and Medical Conditions
[textarea name="other_medical_conditions"]

 GI problems precluding the use of NSAIDs?
 Diabetes/problems precluding the use of steroids?
 Blood thinners?
 Medications for chronic pain?

[/textarea]



Objective
[textarea name="objective"]
[/textarea]
NECK 
Neck Range of Motion: [select name="neck_rom" value="FROM|Decreased ROM"][conditional field="neck_rom" condition="(neck_rom).isNot('FROM')"]
turning right: [select name="neck_rom_turn_right" value="neck|slightly decreased|moderately decreased|markedly decreased"][select name="neck_rom_turn_right_pain" value="|, exacerbates pain|, ameliorates pain"]
turning left: [select name="neck_rom_turn_left" value="normal|slightly decreased|moderately decreased|markedly decreased"][select name="neck_rom_turn_left_pain" value="|, exacerbates pain|, ameliorates pain"]
tilting right: [select name="neck_rom_tilt_right" value="normal|slightly decreased|moderately decreased|markedly decreased"][select name="neck_rom_tilt_right_pain" value="|, exacerbates pain|, ameliorates pain"]
tilting left: [select name="neck_rom_tilt_left" value="normal|slightly decreased|moderately decreased|markedly decreased"][select name="neck_rom_tilt_left_pain" value="|, exacerbates pain|, ameliorates pain"]
Extension: [select name="neck_rom_extension" value="normal|slightly decreased|moderately decreased|markedly decreased"][select name="neck_rom_extension_pain" value="|, exacerbates pain|, ameliorates pain"]
Flexion: [select name="neck_extension" value="normal|slightly decreased|moderately decreased|markedly decreased"][select name="neck_rom_tilt_left_pain" value="|, exacerbates pain|, ameliorates pain"][/conditional]
[select name="neck_tenderness" value="No neck tenderness|Neck tenderness is noted "][conditional field="neck_tenderness" condition="(neck_tenderness).isNot('No neck tenderness')"][text name="neck_tenderness_pain" default=""][/conditional]
Palpation: [select name="neck_tenderness" value="no neck tenderness|neck tenderness is noted "][conditional field="neck_tenderness" condition="(neck_tenderness).isNot('no neck tenderness')"][text name="neck_tenderness_pain" default=""][/conditional][select name="neck_spasm" value="; no spasm is noted|; paracervical spasm is noted"][conditional field="neck_spasm" condition="(neck_spasm).isNot('; no spasm is noted')"][select name="neck_spasm_location" value="| on the right| on the left| bilaterally"][/conditional]

BACK
Back Range of Motion: [select name="spine_rom" value="FROM|Decreased ROM"][conditional field="spine_rom" condition="(spine_rom).isNot('FROM')"]
turning right: [select name="spine_rom_turn_right" value="normal|slightly decreased|moderately decreased|markedly decreased"][select name="spine_rom_turn_right_pain" value="|, exacerbates pain|, ameliorates pain"]
turning left: [select name="spine_rom_turn_left" value="normal|slightly decreased|moderately decreased|markedly decreased"][select name="spine_rom_turn_left_pain" value="|, exacerbates pain|, ameliorates pain"]
tilting right: [select name="spine_rom_tilt_right" value="normal|slightly decreased|moderately decreased|markedly decreased"][select name="spine_rom_tilt_right_pain" value="|, exacerbates pain|, ameliorates pain"]
tilting left: [select name="spine_rom_tilt_left" value="normal|slightly decreased|moderately decreased|markedly decreased"][select name="spine_rom_tilt_left_pain" value="|, exacerbates pain|, ameliorates pain"]
Extension: [select name="back_rom_extension" value="normal|slightly decreased|moderately decreased|markedly decreased"][select name="back_rom_extension_pain" value="|, exacerbates pain|, ameliorates pain"]
Flexion: [select name="back_flexion" value="normal|slightly decreased|moderately decreased|markedly decreased"][select name="back_flexion_pain" value="|, exacerbates pain|, ameliorates pain"][/conditional]
Palpation: [select name="spine_tenderness" value="no spinal tenderness|spinal tenderness is noted "][conditional field="spine_tenderness" condition="(spine_tenderness).isNot('no spinal tenderness')"][text name="spine_tenderness_pain" default=""][/conditional][select name="spine_spasm" value="; no spasm is noted|; paralumbar spasm is noted"][conditional field="spine_spasm" condition="(spine_spasm).isNot('; no spasm is noted')"][select name="spine_spasm_location" value="| on the right| on the left| bilaterally"][/conditional]

SCAR INSPECTION, BACK AND NECK
Scarring: [select name="spine_scar" value="no spinal scar|spinal scar is noted "][conditional field="spine_scar" condition="(spine_scar).isNot('no spinal scar')"][text name="spine_scar_location" default=""][/conditional]
[textarea name="spine_additional_text" default="Spine: additional comments"]


GAIT
[select name="gait_exam" value="normal gait|antalgic gait favoring right|antalgic gait favoring left|abnormal gait"][conditional field="gait_exam" condition="(gait_exam).isNot('normal gait')"][text name="gait_exam_description" default="describe gait abnormality"][/conditional]

REFLEXES
[select name="reflexes_lower" value="KJs and AJs 1+ and symmetrical|KJs and AJs 2+ and symmetrical|KJs and AJs 3+ and symmetrical|Asymmetrical reflexes noted"][conditional field="reflexes_lower" condition="(reflexes_lower).is('Asymmetrical reflexes noted')"]
Left KJ [select name="reflexes_lower_left_KJ" value="not tested|0|1+|2+|3+|4+ with clonus"],    Right KJ [select name="reflexes_lower_right_KJ" value="not tested|0|1+|2+|3+|4+ with clonus"]
Left AJ [select name="reflexes_lower_left_AJ" value="not tested|0|1+|2+|3+|4+ with clonus"],    Right AJ [select name="reflexes_lower_right_AJ" value="not tested|0|1+|2+|3+|4+ with clonus"][/conditional]




Assessment
[textarea name="assessment"][/textarea]


Plan
Return to Work: [textarea name="rtw"][/textarea]

Treatment: [checklist name="treatment" value="ibuprofen 600 mg q6h prn with food|flexeril 10 mg qhs prn|medrol dosepack, use as directed"] [textarea name="treatment_text"][/textarea]

Referral: [checklist name="referral" value="L-spine series|L-spine MRI (non-contrast)|Physical Therapy|Back Specialist"][textarea name="referral_text"][/textarea]

Follow-up: [textarea name="follow_up_text"][/textarea]
Last Name: First Name:
Age: Pronoun:
Job Title:
Start Date: Department/Location: Employer:

recommended follow-up for own medical conditions, not related to return to work

Things to review with your doctor:




====================================

Introduction

first_name last_name is a age year old job_title working in/at job_location, since hired by employer_name on start_date. first_name


Description of Injury


Description of Current Symptoms


Relevant Past Medical History



Other Medications and Medical Conditions




Objective

NECK
Neck Range of Motion:

Palpation:

BACK
Back Range of Motion:
Palpation:

SCAR INSPECTION, BACK AND NECK
Scarring:



Plan
Return to Work:


Treatment:


Referral:


Follow-up:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.61, 79 form elements, 73 boilerplate words, 12 text boxes, 12 text areas, 2 check lists, 36 drop downs, 8 variables, 1 comments, 8 conditionals, 67 total clicks
Questions/General site feedback · Help Ticket

Send Feedback for this SOAPnote

Your email address will not be published. Required fields are marked *

More SOAPnotes by this Author: