Upper Extremity Pain/Injury History
Upper Extremity 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] Associated Joint Symptoms Location: [text] [select value="no|YES"] <-- Stiffness [select value="no|YES"] <-- Redness [select value="no|YES"] <-- Swelling [select value="no|YES"] <-- Locking or catching [select value="no|YES"] <-- Giving way or unstable sensation Dominant hand: [text] Pitfall evaluation: [select value="no|YES"] <-- distal numbness [select value="no|YES"] <-- distal weakness [select value="no|YES"] <-- distal cold sensation, pallor, or cyanosis [select value="no|YES"] <-- fever [select value="no|YES"] <-- neck pain [select value="no|YES"] <-- chest pain Pertinent PMH: [select value="no|YES"] <-- arthritis history [select value="no|YES"] <-- prior extremity pain/injury history [select value="no|YES"] <-- cervical disc history [select value="no|YES"] <-- heart disease history [checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"] reference: contributed by Dr. Scott Moses, creator/author of the Family Practice Notebook [link url="//www.fpnotebook.com" memo="(link)"][/conditional]
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