OMT assessment

[checkbox    name="diagnosis  of   pain" value="#thoracic    back    pain|#low    back    pain|#neck    pain|#shoulder    pain|#elbow    pain|#hip    pain|#knee    pain|#ankle    pain|#foot    pain|#hand    pain|#headache"]

#Somatic    dysfunction    [checkbox name="somatic    dysfunction" value=" of    head    region|of    cervical    region| of    thoracic    region| of    lumbar    region|of    sacral    region|of    pelvic    region|of    upper    extremity    region|of    lower    extremity    region|of    rib    region|of    abdomen/visceral    region"]