PCC NOTE

Dear Dr.[text name="variable_1" default="sample text"],

Thank you for referring this interesting [text name="variable_1" default="sample text"] years old [select name="variable_2001" value="right-handed man|left-handed man|right-handed woman|left-handed woman"], [select name="variable_1740" value="Mr.|Mrs.|Ms."][text name="variable_2" default=""] to Pain Care Clinics at [select name="variable_7642" value="St. Catharines| Hamilton| Mississauga|Kitchener"] on [date name="variable_2000" default=""] with a complaint of [checkbox name="variable_1739" value="upper back pain|lower back pain|headache|neck pain|bilateral shoulder pain|right shoulder right|left shoulder pain|hand pain|right hand pain|left hand pain|bilateral hand  pain|hip pain|knee pain|right foot pain|left foot pain|bilateral foot pain|groin pain|right shoulder pain|left shoulder pain|bilateral shoulder pain"][text name="variable_1738" default="[select name="variable_1" value="choice A|choice B|choice C"]. [select name="variable_1737" value="His|Her"] main complaint is [select name="variable_1736" value="|low back pain|neck pain|shoulder pain|right hand pain|left hand pain|right hip pain|left hip pain|left knee pain|right knee pain|right foot pain|left foot pain|left groin pain|right groin pain"]. [text name="variable_1735" default=""].

<b>HISTORY OF PRESENT ILLNESS</b>
Pain started [text name="variable_1734" default=""] [select name="variable_1733" value=" |years ago|months ago|weeks ago"] as patient explains due to [text name="variable_9" default=""]. [select name="variable_1732" value="He|She"] describes a [select name="constant" value="constant|intermittent|severe constant|on and off"] pain with character of [checkbox name="variable_1731" value="dull|achy|sharp|shooting|burning|tingling|itchy|cramping|numbness|coldness|stabbing|jabbing"] [text name="variable_1730" default=""].
The pain has a severity of [select name="variable_1729" value="0|1|2|3|4|5|6|7|8|9|10"]/10 at the worse, [select name="variable_2729" value="0|1|2|3|4|5|6|7|8|9|10"] at the best, [select name="variable_2729" value="0|1|2|3|4|5|6|7|8|9|10"] on average and [select name="variable_2729" value="0|1|2|3|4|5|6|7|8|9|10"]/10 at the moment.
The pain radiates to [checkbox name="variable_1728" value="both buttocks|bilateral back of thighs|bilateral lateral side of thighs|bilateral medial side of thighs|both calves|both feet|both upper arms|both forearms|both wrists|both hands|right buttock|right leg back of thigh|right leg lateral side of thighs|right leg medial side of thighs|right calves|right foot|right upper arms|right forearms|right wrists|right hands|left buttock|left leg back of thigh|left leg lateral side of thighs|left leg medial side of thighs|left calves|left foot|left upper arms|left forearms|left wrists|left hands "] [text name="variable_80" default=""]

Pain is exacerbated by [checkbox name="variable_1727" value="walking|standing|sitting|lying down|prolonged sitting|prolonged standing|prolonged walking|prolonged lying down|touch|any movement|changing position"] [text name="variable_1726" default=""] and relieved with [checkbox name="variable_1725" value="rest|sitting|lying down|heat pad|cold pad|pain killers|muscle relaxants|walking|standing|bending forward|bending backward"] [text name="variable_81" default=""]

DN4 Score [select name="variable_10" value="0/10|1/10|2/10|3/10|4/10|5/10|6/10|7/10|8/10|9/10|10/10"] 
On an NRS scale the pain rating is [select name="variable_11" value="0/10|1/10|2/10|3/10|4/10|5/10|6/10|7/10|8/10|9/10|10/10"] at its worst, [select name="variable_12" value="0/10|1/10|2/10|3/10|4/10|5/10|6/10|7/10|8/10|9/10|10/10"] at best, on average it is [select name="variable_13" value="0/10|1/10|2/10|3/10|4/10|5/10|6/10|7/10|8/10|9/10|10/10"] and currently the pain is [select name="variable_14" value="0/10|1/10|2/10|3/10|4/10|5/10|6/10|7/10|8/10|9/10|10/10"]. Total BPI Interference Score is [text name="variable_15" default="/70"] 
Fibromyalgia Rapid Screening Tool: [select name="variable_20" value="Form not filled|0/6|1/6|2/6|3/6|4/6|5/6|6/6"], [select name="variable_21" value="is suggestive of|not suggestive of|that can be helpful"] for diagnosis of fibromyalgia. 

<b>CONSULTATIONS</b>

<b>PAST MEDICAL HISTORY</B>
[checkbox name="variable_1724" value="No significant past medical history reported by patient|Diabetes mellitus II| Hypertension| Dyslipidemia|Fibromyalgia|coronary artery disease|myocardial infarction|cardiac arrhythmia|abdominal aortic aneurysm|colon cancer|prostate cancer| breast cancer| compression fracture over lumbar area| compression fracture over her thoracic area| compression fracture over cervical area|GERD|CHF| COPD|IBS|IBD|Asthma| chronic constipation| chronic diarrhea|depression|anxiety|psychosis|bipolar disorder|obsessive-compulsive disorder|personality disorder|ADHD|Autism"] [text name="variable_1723" default=""]

<B>PAST SURGICAL HISTORY</B>
[textarea name="variable_1" default="sample text"]


<B>FAMILY HISTORY</B>
[checkbox name="variable_1722" value="No significant family history reported by patient|Diabetes mellitus II|Fibromyalgia| hypertension| dyslipidemia| coronary artery disease| heart attack at young age| cardiac arrhythmia| colon cancer| prostate cancer| breast cancer| compression fracture|depression| anxiety| psychosis| bipolar disorder| obsessive-compulsive disorder| personality disorder| ADHD| autism"] [text name="variable_584" default=""]

<B>FUNCTIONAL INQUIRY</B>
General functional inquiry including cardiovascular, respiratory, gastrointestinal, genitourinary, hematological and endocrine systems was unremarkable at the moment. No other musculoskeletal issues were reported.

<B>PREVIOUS INVESTIGATIONS</B>
X-rays:
[textarea name="variable_27" default="X-ray"]
CT:
[textarea name="variable_28" default="CT Scan"] 
MRI:
[textarea name="variable_29" default="MRI"] 
U/S:
[textarea name="variable_30" default="Ultrasound"] 
Other:
[textarea name="variable_31" default="Other tests"]

<b>PAST PAIN MEDICATIONS</b>
[select name="variable_660" value="He|She"] [select name="variable_662" value="has tried|is taking|has not tried"] [checkbox name="variable_661" value="Tylenol|Different types of NSAIDS|Advil|Naproxen|Meloxicam|Gabapentin|Lyrica|Cymbalta|Elavil|Tramadol|Tylenol 1|Tylenol 2|Tylenol 3|Tylenol 4|Percocet|Hydromorphone IR|Hydromorphone CR|Dilaudid|Morphine IR|Morphine SR|Fentanyl patch|Suboxone|Medical cannabis inhalation|Cannabis Oil"]. [text name="variable_1720" default=""]

<b>CURRENT MEDICATIONS</b>
[checkbox name="variable_582" value="Tylenol|Different types of NSAIDS|Advil|Naproxen|Meloxicam|Gabapentin|Lyrica|Cymbalta|Elavil|Tramadol| Tylenol 1|Tylenol 2|Tylenol 3|Tylenol 4|Percocet|Hydromorphone IR|Hydromorphone CR|Dilaudid|Morphine IR|Morphine SR|Fentanyl patch|Suboxone|MedicalCannabis inhalation|Cannabis Oil"]. [text name="variable_1721" default=""]

<b>PAST THERAPIES</b>
[checkbox name="variable_20" value="No physical therapy has been done|Physiotherapy|Massage therapy|Chiropractic Treatment|Accupuncture|Thai Chi|Aquatic Therapy|Swimming|Cognitive Behavioral Therapy|Biofeedback|Hypnotic Therapy|Meditation and Mindfullness|regular home exercises"]
[text name="variable_21" default=""]


<b> ALLERGIES </b> Patient [select name="variable_4010" value="has no known drug allergies|has allergies to"] [text name="variable_3999" default=""] and [select name="variable_3998" value="has no environmental allergies.|has environmental allergies"] [text name="variable_3997" default=""]

<b>SOCIAL HISTORY</b>
Patient is currently [select name="variable_22" value="single|married|divorced|widowed|has common law|separated"],lives [select name="variable_23" value="alone|with family|with his wife|with her husband|with his common law|with her common law|with her boyfriend|with his girlfriend|in shelter alone"] [text name="variable_24" default=""] and has [select name="variable_25" value="no|one|two|three|four|five|six|seven|eight|nine|10"] children [text name="variable_26" default=""].
[select name="variable_27" value="He|She"] [select name="variable_56" value="is unemployed|works as|retired |on disability|on WSIB|on ODSP"] [text name="variable_28" default=""]
Smoking: [checkbox name="variable_29" value="Non smoker|Ex-Smoker|Current smoker"] [text name="variable_140" default=""]
ETOH: [checkbox name="variable_30" value="Not a drinker|Drinks Socially|Current drinker."] [text name="variable_139" default=""]
Recreational Drugs: [checkbox name="variable_55" value="None|Uses socially|Current user"] [text name="variable_138" default=""]

<b>PSYCHOLOGICAL STATUS AND RELATED MATTERS</b>
[select name="variable_4005" value="He|She"] [select name="variable_4001" value="has no psychiatric problem|has"] [checkbox name="variable_4004" value="Depression|Anxiety|Bipolar Disorder|OCD|Psychosis|Suicide attempt|Suicide thoughts|Personality Disorder|Addiction|Drug Dependence|PTSD"] [select name="variable_4002" value="and does not see a psychiatrist|sees a psychiatrist regularly|sees a psychatrist, last time had been|"] [text name="variable_4003" default=""]

<b>SLEEP</b>
Sleep is generally[checkbox name="variable_153" value="unrefreshing|refreshing|has problems with initiating sleep| has no problem with initiating sleep| has problem with maintaining sleep| has no problem with maintaining sleep|wakes up several times at night due to pain|takes medication to help with sleep"] [text name="variable_586" default=""]

<b>SEXUAL LIFE</b>
[checkbox name="variable_154" value="Has no problem with sexual life and is not concerned| Has problem with sexual life but is not concerned about this issue | has problem with desire in regards with sexual performance| has sexual problem in performance due to pain| has sexual problem due to medication side effects"]
[text name="variable_587" default=""]


<B>ADDICTION RISK</B>
1. Worsening AM pain[select name="M1" value="Yes|No"]
2. Maximum EtOH 
[text name="variable_1" default="sample text"] 
4. Alcohol CAGE: 
[checklist name="variable_1" value="NEGATIVE|POSITIVE"]
5. Nicotine: 
[checklist name="variable_1" value="NEGATIVE|POSITIVE"]
6. Prescription drugs off the street?[checklist name="variable_1" value="NEGATIVE|POSITIVE"]
Prescription drugs borrowed?[checklist name="variable_1" value="NEGATIVE|POSITIVE"]
7. Family psychiatric history [select value= NO|YES]
8. Family history of substance abuse [select value= NO|YES]
9. Personal history of trauma? [select value= NO|YES]
Personal history of emotional abuse? [select value= NO|YES]
Personal history of sexual abuse? [select value= NO|YES] 
10. Personal history of substance abuse [select value= NO|YES] 
11. Has the patient ever received treatment for drug abuse? [select value= NO|YES]
6. UDS: 
[checklist name="variable_1" value="NEGATIVE|THC|MORPHINE|OXY|AMPHETAMINE|BENZO|HYDROMORPHONE|"]

PHYSICAL EXAMINATION: 

Height: [text name="variable_2" default=""] cm.
Weight: [text name="variable_2" default=""] kg. 
BMI: [text name="variable_2" default=""]
BP: [text name="variable_2" default=""] 
HR: [text name="variable_2" default=""] 

On physical exam today, I found the patient to be [select name="variable_31" value="Alert and cooperative|non cooperative|confused"], [select name="variable_32" value="well|poorly"] oriented to person, place and time. The communication skills, recent and remote memory [select name="variable_34" value="are intact|are impaired|poor"].[select name="variable_35" value="normal|poor"] insight and judgment, affect and mood appeared [select name="variable_36" value="congruent and within normal limits|non congruent|are congruent and down"], was[select name="variable_37" value="able|not able"] to follow commands and cooperated with the examination.
Body Type is [select name="variable_38" value="normal|slightly overweight| overweight|frail"] and appears [select name="variable_39" value="well|poorly"] conditioned. Gait[select name="variable_40" value="is normal|ant[var name="variable_name"]algic|is shuffling gait|is wide base gait| cannot be assessed|can not be assessed, sits on wheelchair"] with [select name="variable_611" value="upright|mildly kyphotic|kyphotic|stooped forward"] posture, has [select name="variable_8463" value="normal|slow"] get up and go.[text name="variable_3001" default=""]

Systemic Examination:
[select name="Q1" value="|Head and Face|Neck|Upper Back|Low Back|R/L Shoulder|R/L Elbow|R/L Wrist|R/L Hip|R/L Knee|R/L Ankle/Foot"][conditional field="Q1" condition="(Q1).is('Neck')"]

Inspection of the neck and cervical spine [select name="variable_746" value="there is no|there is"] signs of muscle spasm,
muscle wasting, skin changes [text name="variable_747" default="."]
[select name="variable_745" value="There is no tenderness over cervical spinous process and paraspinous muscles.| There is tenderness over spinous process and paraspinous muscles.|There is tenderness over spinous process|There is tenderness over paraspinous muscles."] [text name="variable_748" default=""]
Forward flexion [select name="variable_1799" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain on movement,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|decreased severely,"]Extension [select name="variable_1798" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain on movement,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|decreased severely,"]Left Lateral bending [select name="variable_1797" value="|Full,|Normal but patient reports pain,|Decreased and patient reports pain on movement,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|decreased severely,"]Right Lateral bending [select name="variable_1796" value="|Full,|Normal but patient reports pain,|Decreased and patient reports pain on movement,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|decreased severely,"] [select name="variable_4080" value="are within acceptable ranges and not causing pain.|."]
Strength checked with resisted internal rotation, external rotation,resisted flexion and extension [select name="variable_767" value="were within normal limits|revealed weakness over"] [text name="variable_768" default=""]
Spurling test [select name="variable_760" value=",|was negative|was positive|caused pain|caused pain over right side|caused pain over left side"]Cervical compression test [select name="variable_761" value=" |elicit pain|caused pain|was negative|was positive"][select name="variable_4081" value="were negative| "]
Light touch of face and neck [select name="variable_762" value="did not reveal|showed"] allodynia , hypoesthesia.
[/conditional][conditional field="Q1" condition="(Q1).is('R/L Shoulder')"]
Inspection of both exposed shoulders from front and back, there [select name="variable_156" value="is no|is"] asymmetry, atrophy, swelling, ecchymosis, venous distention.[text name="variable_158" default=""]Apprehension test for shoulder stability was [select name="variable_159" value="negative bilaterally|positive right side|positive left side"]. Palpation of sternoclavicular joint[select name="variable_4050" value=",|(is tender),|(is mildly tender),"]clavicle[select name="variable_4051" value=",|(is tender),|(is mildly tender),"]AC joint[select name="variable_4052" value=",|(is tender),|(is mildly tender),"]bicipital groove[select name="variable_4053" value=",|(is tender),|(is mildly tender),"]glenohumeral joint[select name="variable_4055" value=",|(is tender),|(is mildly tender),"]anterior subacromial space[select name="variable_4056" value=",|(is tender),|(is mildly tender),"]posterior subacromial space[select name="variable_4057" value=",|(is tender),|(is mildly tender),"]rotator cuff tendons [select name="variable_161" value="did not elicit tenderness|caused tenderness over|."][text name="variable_691" default=""]
There [select name="variable_162" value="is no tenderness over the spinous process and paraspinous muscles.|is tenderness over the spinous process.|is tenderness over the paraspinous muscles."]
Range of motion performed actively and passively in forward flexion [select name="variable_165" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]extension [select name="variable_166" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]abduction[select name="variable_177" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]external rotation[select name="variable_167" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]internal rotation[select name="variable_168" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]horizontal abduction[select name="variable_169" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"] [select name="variable_4060" value="are within acceptable ranges|are within normal limits|."] [text name="variable_4061" default=""]
Strength checked with resisted internal rotation, external rotation, resisted abduction and adduction are [select name="variable_170" value="within normal limits|revealed weakness of"] [text name="variable_171" default=""]
Speed test [select name="variable_172" value=",|was negative bilaterally|was positive bilaterally|was positive over right shoulder|was positive over left shoulder"] Neer's test [select name="variable_173" value=",|was negative bilaterally|was positive bilaterally|was positive over right shoulder|was positive over left shoulder "] Labrum grind test [select name="variable_174" value=" were negative bilaterally|was positive bilaterally|was positive over right shoulder|was positive over left shoulder "].[text name="variable_3002" default=""]
[/conditional][conditional field="Q1" condition="(Q1).is('R/L Elbow')"]
Inspection: [checkbox value="No gross deformity|EDEMA|EFFUSION|ECCHYMOSIS"]. [text size="30"]

Palpation: [select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="olecranon|antecubital fossa|medial epicondyle|lateral epicondyle"]. [text size="40"]

ROM: [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension"]
[text size="50"][/conditional][conditional field="Q1" condition="(Q1).is('R/L Wrist')"]
Inspection: [select value="No gross deformity|GROSS DEFORMITY-"] [text size="30"]

Palpation: [select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="dorsal aspect|volar aspect|medial aspect|lateral aspect"]. [text size="40"]

ROM: [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension|abduction/adduction"]. [text size="40"]

Special tests:
-Tinel's test [select value="negative|POSITIVE"]
-Phalen's test [select value="negative|POSITIVE"]
-Reverse phalen's test [select value="negative|POSITVE"]
-Finklestein's test [select value="negative|POSITVE"]
[text size="50"][/conditional][conditional field="Q1” condition="(Q1).is('Upper Back')"]
Inspection:
-[checkbox value="No gross deformity|LEFT-SIDED PARASPINAL MUSCLE SPASM|RIGHT-SIDED PARASPINAL MUSCLE SPASM|GROSS/EXCESS LATERAL SPINAL CURVATURE|R SCAPULAR WINGING|L SCAPULAR WINGING"]. [text size="30"]
-[checkbox value="No gait abnormalities|ANTALGIC GAIT|TRENDELENBURG GAIT"].

Palpation:
-[select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="R 1st rib|L 1st rib|R paraspinals|L paraspinals|midline/spinous processes|R upper trapezius|L upper trapezius|R lower trapezius|L lower trapezius"].
-[select value="No step-offs noted|ABNORMAL STEP-OFF NOTED-"] [text size="40"]

ROM: Thoracolumbar [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension|right side-bend|left side-bend|right rotation|left rotation"]. [text size="40"]

Special tests:
-Spurling's test [select value="negative b/l|R POSITIVE|L POSITIVE"].
-Axial compression test [select value="negative|POSITIVE"]
[text size="50"][/conditional][conditional field="Q1" condition="(Q1).is('Low Back')"]
Inspection of entire back [select name="variable_1790" value="Did not show any|showed"] redness, asymmetry, deformity, scoliosis, hair growth and Step off deformity[text name="variable_18" default="."]
Palpation of Spinous process [select name="variable_9004" value=",|is tender,"]Paraspinous muscles[select name="variable_9005" value=",|is tender,"]Sacroiliac joints[select name="variable_4006" value=",|is tender,"]Tip of coccyx[select name="variable_4007" value=",|is tender,"]paravertebral muscles[select name="variable_4008" value=",|is tender,"] [select name="variable_4009" value="are non tender|.|mildly tender"]. [text name="variable_4010" default=""]
Range of motion in Forward flexion [select name="variable_4011" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|severely reduced,"]Extension [select name="variable_4012" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|severely reduced,"]Lateral bendings[select name="variable_4013" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|severely reduced,"]Twisting [select name="variable_4014" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|severely reduced,"] [select name="variable_4015" value="are within acceptable ranges.|are within normal limits.|."][text name="variable_4016" default=""]
Strength testing on Heel walking[select name="variable_4017" value=",|show bilateral weakness|weakness over right side|weakness over left side"]sideToe walking[select name="variable_4018" value=",|show bilateral weakness|weakness over right side|weakness over left side"]Resisted great toe dorsiflexion [select name="variable_4018" value=",|show bilateral weakness|weakness over right side|weakness over left side"] [select name="variable_4019" value="did not show signs of weakness bilaterally.|."][text name="variable_4020" default=""]
Deep tendon reflexes over knee and ankle [select name="variable_1882" value="2+ and symetric|1+ and symetric|weak bilateraly"]. Straight-leg raise [checkbox name="variable_1881" value="Positive less than 60 degree|Positive between 60 and 90 degrees|Negative"] [select name="variable_1880" value="Bilaterally|Left side|Right side"] [text name="variable_674" default=""]
Dorsiflexion of ankle during straight-leg raise test [select name="variable_1879" value="did not Increased|increased"] sciatic tension and pain [select name="variable_1878" value="Bilaterally|over right side|Over left side"]. Ankle clonus was negative, Negative babinsky sign.
Sensation over L4, L5, S1, Obturator and Femoral nerve distributions [select name="variable_1850" value="are within normal limits|showed decreased sensation over"] [text name="variable_1877" default=""]. There [select name="variable_1876" value="is no|is"] allodynia, Hypoesthesia or Hyperesthesia over lower extremities.
Distal pulses of dorsalis pedis and posterior tibialis [select name="variable_1875" value="are palpable|palpable but weak|barely palpable|are not palpable"] [text name="variable_3004" default=""]
Special tests:
Patrick test [select name="variable_1874" value="Did not elicit|elicited"] SI joint/Groin pain [select name="variable_887" value="bilaterally|over left side|over right side"]. Stork test [select name="variable_1849" value="Did not|Did"] elicits lower back pain [select name="variable_888" value="bilaterally|over left side|over right side"] [text name="variable_3004" default=""]
[/conditional][conditional field="Q1" condition="(Q1).is('R/L Hip')"]
Hip Exam
Inspection of hip from front and back [select name="variable_901" value="had no asymmetry,atrophy or pelvic tilt|some asymmetry noted over|atrophy noted over|asymmetry and atrophy noted over"] [text name="variable_902" default=""]
Palpation of Anterior hip joint[select name="variable_4090" value=",|(caused pain over right side|(caused pain over left side)"]anterior superior iliac spine[select name="variable_4091" value=",|(caused pain over right side|(caused pain over left side)"]anterior inferior iliac spine[select name="variable_4092" value=",|(caused pain over right side|(caused pain over left side)"]greater trochanter[select name="variable_4093" value=",|(caused pain over right side|(caused pain over left side)"]iliotibial band[select name="variable_4094" value=",|(caused pain over right side|(caused pain over left side)"]gluteus muscle area[select name="variable_4095" value=",|(caused pain over right side|(caused pain over left side)"]Ischial bursa[select name="variable_4096" value=",|(caused pain over right side|(caused pain over left side)"]Trochanteric bursa[select name="variable_4097" value=",|(caused pain over right side|(caused pain over left side)"]SI joint[select name="variable_4098" value=",|(caused pain over right side|(caused pain over left side)"][select name="variable_904" value="did not ilicit tenderness|caused tenderness over|were not tender but patient reported pain on deep palpation of"] [text name="variable_905" default=""]
Range of motion with Internal rotation [select name="variable_906" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]external rotation [select name="variable_907" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]flexion[select name="variable_908" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]extension [select name="variable_909" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]abduction[select name="variable_910" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]adduction[select name="variable_911" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"] [select name="variable_4099" value="are in acceptable ranges and do not cause pain on movements.| "]
[text name="variable_914" default=""]strengths examination [select name="variable_912" value="within normal limits bilaterally|revealed weakness bilaterally|revealed weakness left side|revealed weakness right side"]. [text name="variable_915" default=""]
Light touch [select name="variable_913" value="did not|did"] elicit hyperesthesia or allodynia.
Sensation over lateral thigh and medial thigh [select name="variable_917" value="were normal|were absent|slightly decreased"]. [text name="variable_918" default=""]
Trendelenburg test [select name="variable_919" value="did not|did"] elicit pelvic tilt, weakness or pain.
[text name="variable_920" default=""]. Logroll test negative.[text name="variable_1441" default=""]
[/conditional][conditional field="Q1" condition="(Q1).is('R/L Knee')"]
Inspection:
-[checkbox value="No gross deformity|GROSS EFFUSION|ECCHYMOSIS|LATERALLY DISPLACED PATELLA"][text size="30"]
-[select value="No gait abnormalities|GAIT ABNORMALITIES"] - [checkbox value="VARUS THRUST|ANTALGIC|LATERAL PATELLAR TRACKING|FLEXED KNEE GAIT"]
[text size="40"]

Palpation:
-[select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="Patellar tendon|Medial Joint Line|Lateral Joint Line|Pes Anserine Bursa|Quad tendon|IT Band|LCL Ligament|MCL Ligament|Popliteal Fossa"].
-[select value="No palpable baker's cyst|PALPABLE BAKER'S CYST"].
[text size="40"]

ROM: [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension|internal rotation|external rotation"]
[text size="40"]

Special tests:
-Patellar apprehenson test [select value="negative|POSITIVE"]
-Varus test [select value="negative|POSITIVE"]
-Valgus test [select value="negative|POSITIVE"]
-Lachman's test [select value="negative|POSITIVE"]
-Anterior drawer test [select value="negative|POSITIVE"]
-Posterior drawer test [select value="negative|POSITIVE"]
-McMurray's test [select value="negative|POSITIVE"]
-Thessaly test [select value="negative|POSITIVE"]
[text area][/conditional][conditional field="Q1" condition="(Q1).is('R/L Ankle/Foot')"]
Inspection:
-Ankle- [checkbox value="No gross deformity|GROSS EFFUSION|ECCHYMOSIS|GROSS DISLOCATION"][text size="30"]
-Foot- [checkbox value="Normal height of plantar arches with weight bearing|HIGH ARCHES with weight bearing|REDUCED PLANTAR ARCH HEIGHTS with weight bearing|COMPLETE COLLAPSE OF PLANTAR ARCHES with weight bearing|R Hallux Valgus|L Hallux Valgus|Unable to assess d/t distracting pain"]
-[select value="No gait abnormalities|GAIT ABNORMALITIES-"] [checkbox value="ANTALGIC but able to bear weight|UNABLE TO WEIGHT BEAR ON AFFECTED ANKLE|UNABLE TO WEIGHT BEAR ON AFFECTED FOOT"]
[text size="40"]

Palpation:
-[select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="distal fibula|anterior talofibular ligament (ATFL)|posterior talofibular ligament (PTFL)|calcaneal fibular ligament (CFL)|distal tibia/lateral malleolus|medial malleolus|deltoid ligament complex|base of 5th metatarsal|dorsal aspect of navicular bone|proximal fibula"].
[text size="40"]

ROM:
Ankle- [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension|ankle inversion|ankle everson"]
Foot- [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="hallux flexion|hallux extension|flexion of lesser toes|extension of lesser toes|foot inversion|foot everson"]
[text size="40"]

Special tests:
-Talar tilt test [select value="negative|POSITIVE"]
-Anterior drawer test [select value="negative|POSITIVE"]
-Squeeze test [select value="negative|POSITIVE"]
-Ankle External Rotation Test (Syndesmotic Stress Test) [select value="negative|POSITIVE"],Thompson test [select value="negative|POSITIVE"][text size="40"]
[/conditional][conditional field="Q1" condition="(Q1).is('Head and Face')"]
Power is [select name="variable_150" value="normal bilaterally|weak right side|weak left side"].Sensation to light touch is [select name="variable_151" value="intact|decreased over left side|decreased over right side"].there [select name="variable_152" value="is no|is"] hyperesthesia,hypoesthesia, allodynia. Palpation of TMJ region[select name="variable_4070" value=",|(is tender right side|is tender left side|is tender bilaterally"]supraorbital[select name="variable_4071" value=",|(is tender right side|is tender left side|is tender bilaterally"]infraorbital[select name="variable_4072" value=",|(is tender right side|is tender left side|is tender bilaterally"]temporal area[select name="variable_4073" value=",|(is tender right side|is tender left side|is tender bilaterally"]lesser and greater occipital nerve region[select name="variable_4074" value=",|(is tender right side|is tender left side|is tender bilaterally"]Splenius Capitus[select name="variable_4075" value=",|(is tender right side|is tender left side|is tender bilaterally"]sternocleidomastoid[select name="variable_4075" value=",|(is tender right side|is tender left side|is tender bilaterally"] [select name="variable_154" value="are non tender.|."] There is no evidence of bruxism.[text name="variable_155" default=""]

[comment memo="Adapted from content on https://fpnotebook.com/Ortho/Exam/AnklExm.htm"][/conditional]

[select name="Q2" value="|Head and Face|Neck|Upper Back|Low Back|R/L Shoulder|R/L Elbow|R/L Wrist|R/L Hip|R/L Knee|R/L Ankle/Foot"][conditional field="Q2" condition="(Q2).is('Neck')"]
Inspection of the neck and cervical spine [select name="variable_746" value="there is no|there is"] signs of muscle spasm,
muscle wasting, skin changes [text name="variable_747" default="."]
[select name="variable_745" value="There is no tenderness over cervical spinous process and paraspinous muscles.| There is tenderness over spinous process and paraspinous muscles.|There is tenderness over spinous process|There is tenderness over paraspinous muscles."] [text name="variable_748" default=""]
Forward flexion [select name="variable_1799" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain on movement,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|decreased severely,"]Extension [select name="variable_1798" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain on movement,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|decreased severely,"]Left Lateral bending [select name="variable_1797" value="|Full,|Normal but patient reports pain,|Decreased and patient reports pain on movement,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|decreased severely,"]Right Lateral bending [select name="variable_1796" value="|Full,|Normal but patient reports pain,|Decreased and patient reports pain on movement,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|decreased severely,"] [select name="variable_4080" value="are within acceptable ranges and not causing pain.|."]
Strength checked with resisted internal rotation, external rotation,resisted flexion and extension [select name="variable_767" value="were within normal limits|revealed weakness over"] [text name="variable_768" default=""]
Spurling test [select name="variable_760" value=",|was negative|was positive|caused pain|caused pain over right side|caused pain over left side"]Cervical compression test [select name="variable_761" value=" |elicit pain|caused pain|was negative|was positive"][select name="variable_4081" value="were negative| "]
Light touch of face and neck [select name="variable_762" value="did not reveal|showed"] allodynia , hypoesthesia.
[/conditional][conditional field="Q2" condition="(Q2).is('R/L Shoulder')"]
Inspection of both exposed shoulders from front and back, there [select name="variable_156" value="is no|is"] asymmetry, atrophy, swelling, ecchymosis, venous distention.[text name="variable_158" default=""]Apprehension test for shoulder stability was [select name="variable_159" value="negative bilaterally|positive right side|positive left side"]. Palpation of sternoclavicular joint[select name="variable_4050" value=",|(is tender),|(is mildly tender),"]clavicle[select name="variable_4051" value=",|(is tender),|(is mildly tender),"]AC joint[select name="variable_4052" value=",|(is tender),|(is mildly tender),"]bicipital groove[select name="variable_4053" value=",|(is tender),|(is mildly tender),"]glenohumeral joint[select name="variable_4055" value=",|(is tender),|(is mildly tender),"]anterior subacromial space[select name="variable_4056" value=",|(is tender),|(is mildly tender),"]posterior subacromial space[select name="variable_4057" value=",|(is tender),|(is mildly tender),"]rotator cuff tendons [select name="variable_161" value="did not elicit tenderness|caused tenderness over|."][text name="variable_691" default=""]
There [select name="variable_162" value="is no tenderness over the spinous process and paraspinous muscles.|is tenderness over the spinous process.|is tenderness over the paraspinous muscles."]
Range of motion performed actively and passively in forward flexion [select name="variable_165" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]extension [select name="variable_166" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]abduction[select name="variable_177" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]external rotation[select name="variable_167" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]internal rotation[select name="variable_168" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]horizontal abduction[select name="variable_169" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"] [select name="variable_4060" value="are within acceptable ranges|are within normal limits|."] [text name="variable_4061" default=""]
Strength checked with resisted internal rotation, external rotation, resisted abduction and adduction are [select name="variable_170" value="within normal limits|revealed weakness of"] [text name="variable_171" default=""]
Speed test [select name="variable_172" value=",|was negative bilaterally|was positive bilaterally|was positive over right shoulder|was positive over left shoulder"] Neer's test [select name="variable_173" value=",|was negative bilaterally|was positive bilaterally|was positive over right shoulder|was positive over left shoulder "] Labrum grind test [select name="variable_174" value=" were negative bilaterally|was positive bilaterally|was positive over right shoulder|was positive over left shoulder "].[text name="variable_3002" default=""]
[/conditional][conditional field="Q2" condition="(Q2).is('R/L Elbow')"]
Inspection: [checkbox value="No gross deformity|EDEMA|EFFUSION|ECCHYMOSIS"]. [text size="30"]

Palpation: [select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="olecranon|antecubital fossa|medial epicondyle|lateral epicondyle"]. [text size="40"]

ROM: [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension"]
[text size="50"][/conditional][conditional field="Q2" condition="(Q2).is('R/L Wrist')"]
Inspection: [select value="No gross deformity|GROSS DEFORMITY-"] [text size="30"]

Palpation: [select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="dorsal aspect|volar aspect|medial aspect|lateral aspect"]. [text size="40"]

ROM: [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension|abduction/adduction"]. [text size="40"]

Special tests:
-Tinel's test [select value="negative|POSITIVE"]
-Phalen's test [select value="negative|POSITIVE"]
-Reverse phalen's test [select value="negative|POSITVE"]
-Finklestein's test [select value="negative|POSITVE"]
[text size="50"][/conditional][conditional field="Q2” condition="(Q2).is('Upper Back')"]
Inspection:
-[checkbox value="No gross deformity|LEFT-SIDED PARASPINAL MUSCLE SPASM|RIGHT-SIDED PARASPINAL MUSCLE SPASM|GROSS/EXCESS LATERAL SPINAL CURVATURE|R SCAPULAR WINGING|L SCAPULAR WINGING"]. [text size="30"]
-[checkbox value="No gait abnormalities|ANTALGIC GAIT|TRENDELENBURG GAIT"].

Palpation:
-[select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="R 1st rib|L 1st rib|R paraspinals|L paraspinals|midline/spinous processes|R upper trapezius|L upper trapezius|R lower trapezius|L lower trapezius"].
-[select value="No step-offs noted|ABNORMAL STEP-OFF NOTED-"] [text size="40"]

ROM: Thoracolumbar [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension|right side-bend|left side-bend|right rotation|left rotation"]. [text size="40"]

Special tests:
-Spurling's test [select value="negative b/l|R POSITIVE|L POSITIVE"].
-Axial compression test [select value="negative|POSITIVE"]
[text size="50"][/conditional][conditional field="Q2" condition="(Q2).is('Low Back')"]
Inspection of entire back [select name="variable_1790" value="Did not show any|showed"] redness, asymmetry, deformity, scoliosis, hair growth and Step off deformity[text name="variable_18" default="."]
Palpation of Spinous process [select name="variable_9004" value=",|is tender,"]Paraspinous muscles[select name="variable_9005" value=",|is tender,"]Sacroiliac joints[select name="variable_4006" value=",|is tender,"]Tip of coccyx[select name="variable_4007" value=",|is tender,"]paravertebral muscles[select name="variable_4008" value=",|is tender,"] [select name="variable_4009" value="are non tender|.|mildly tender"]. [text name="variable_4010" default=""]
Range of motion in Forward flexion [select name="variable_4011" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|severely reduced,"]Extension [select name="variable_4012" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|severely reduced,"]Lateral bendings[select name="variable_4013" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|severely reduced,"]Twisting [select name="variable_4014" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|severely reduced,"] [select name="variable_4015" value="are within acceptable ranges.|are within normal limits.|."][text name="variable_4016" default=""]
Strength testing on Heel walking[select name="variable_4017" value=",|show bilateral weakness|weakness over right side|weakness over left side"]sideToe walking[select name="variable_4018" value=",|show bilateral weakness|weakness over right side|weakness over left side"]Resisted great toe dorsiflexion [select name="variable_4018" value=",|show bilateral weakness|weakness over right side|weakness over left side"] [select name="variable_4019" value="did not show signs of weakness bilaterally.|."][text name="variable_4020" default=""]
Deep tendon reflexes over knee and ankle [select name="variable_1882" value="2+ and symetric|1+ and symetric|weak bilateraly"]. Straight-leg raise [checkbox name="variable_1881" value="Positive less than 60 degree|Positive between 60 and 90 degrees|Negative"] [select name="variable_1880" value="Bilaterally|Left side|Right side"] [text name="variable_674" default=""]
Dorsiflexion of ankle during straight-leg raise test [select name="variable_1879" value="did not Increased|increased"] sciatic tension and pain [select name="variable_1878" value="Bilaterally|over right side|Over left side"]. Ankle clonus was negative, Negative babinsky sign.
Sensation over L4, L5, S1, Obturator and Femoral nerve distributions [select name="variable_1850" value="are within normal limits|showed decreased sensation over"] [text name="variable_1877" default=""]. There [select name="variable_1876" value="is no|is"] allodynia, Hypoesthesia or Hyperesthesia over lower extremities.
Distal pulses of dorsalis pedis and posterior tibialis [select name="variable_1875" value="are palpable|palpable but weak|barely palpable|are not palpable"] [text name="variable_3004" default=""]
Special tests:
Patrick test [select name="variable_1874" value="Did not elicit|elicited"] SI joint/Groin pain [select name="variable_887" value="bilaterally|over left side|over right side"]. Stork test [select name="variable_1849" value="Did not|Did"] elicits lower back pain [select name="variable_888" value="bilaterally|over left side|over right side"] [text name="variable_3004" default=""]
[/conditional][conditional field="Q2" condition="(Q2).is('R/L Hip')"]
Hip Exam
Inspection of hip from front and back [select name="variable_901" value="had no asymmetry,atrophy or pelvic tilt|some asymmetry noted over|atrophy noted over|asymmetry and atrophy noted over"] [text name="variable_902" default=""]
Palpation of Anterior hip joint[select name="variable_4090" value=",|(caused pain over right side|(caused pain over left side)"]anterior superior iliac spine[select name="variable_4091" value=",|(caused pain over right side|(caused pain over left side)"]anterior inferior iliac spine[select name="variable_4092" value=",|(caused pain over right side|(caused pain over left side)"]greater trochanter[select name="variable_4093" value=",|(caused pain over right side|(caused pain over left side)"]iliotibial band[select name="variable_4094" value=",|(caused pain over right side|(caused pain over left side)"]gluteus muscle area[select name="variable_4095" value=",|(caused pain over right side|(caused pain over left side)"]Ischial bursa[select name="variable_4096" value=",|(caused pain over right side|(caused pain over left side)"]Trochanteric bursa[select name="variable_4097" value=",|(caused pain over right side|(caused pain over left side)"]SI joint[select name="variable_4098" value=",|(caused pain over right side|(caused pain over left side)"][select name="variable_904" value="did not ilicit tenderness|caused tenderness over|were not tender but patient reported pain on deep palpation of"] [text name="variable_905" default=""]
Range of motion with Internal rotation [select name="variable_906" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]external rotation [select name="variable_907" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]flexion[select name="variable_908" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]extension [select name="variable_909" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]abduction[select name="variable_910" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]adduction[select name="variable_911" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"] [select name="variable_4099" value="are in acceptable ranges and do not cause pain on movements.| "]
[text name="variable_914" default=""]strengths examination [select name="variable_912" value="within normal limits bilaterally|revealed weakness bilaterally|revealed weakness left side|revealed weakness right side"]. [text name="variable_915" default=""]
Light touch [select name="variable_913" value="did not|did"] elicit hyperesthesia or allodynia.
Sensation over lateral thigh and medial thigh [select name="variable_917" value="were normal|were absent|slightly decreased"]. [text name="variable_918" default=""]
Trendelenburg test [select name="variable_919" value="did not|did"] elicit pelvic tilt, weakness or pain.
[text name="variable_920" default=""]. Logroll test negative.[text name="variable_1441" default=""]
[/conditional][conditional field="Q2" condition="(Q2).is('R/L Knee')"]
Inspection:
-[checkbox value="No gross deformity|GROSS EFFUSION|ECCHYMOSIS|LATERALLY DISPLACED PATELLA"][text size="30"]
-[select value="No gait abnormalities|GAIT ABNORMALITIES"] - [checkbox value="VARUS THRUST|ANTALGIC|LATERAL PATELLAR TRACKING|FLEXED KNEE GAIT"]
[text size="40"]

Palpation:
-[select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="Patellar tendon|Medial Joint Line|Lateral Joint Line|Pes Anserine Bursa|Quad tendon|IT Band|LCL Ligament|MCL Ligament|Popliteal Fossa"].
-[select value="No palpable baker's cyst|PALPABLE BAKER'S CYST"].
[text size="40"]

ROM: [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension|internal rotation|external rotation"]
[text size="40"]

Special tests:
-Patellar apprehenson test [select value="negative|POSITIVE"]
-Varus test [select value="negative|POSITIVE"]
-Valgus test [select value="negative|POSITIVE"]
-Lachman's test [select value="negative|POSITIVE"]
-Anterior drawer test [select value="negative|POSITIVE"]
-Posterior drawer test [select value="negative|POSITIVE"]
-McMurray's test [select value="negative|POSITIVE"]
-Thessaly test [select value="negative|POSITIVE"]
[text area][/conditional][conditional field="Q2" condition="(Q2).is('R/L Ankle/Foot')"]
Inspection:
-Ankle- [checkbox value="No gross deformity|GROSS EFFUSION|ECCHYMOSIS|GROSS DISLOCATION"][text size="30"]
-Foot- [checkbox value="Normal height of plantar arches with weight bearing|HIGH ARCHES with weight bearing|REDUCED PLANTAR ARCH HEIGHTS with weight bearing|COMPLETE COLLAPSE OF PLANTAR ARCHES with weight bearing|R Hallux Valgus|L Hallux Valgus|Unable to assess d/t distracting pain"]
-[select value="No gait abnormalities|GAIT ABNORMALITIES-"] [checkbox value="ANTALGIC but able to bear weight|UNABLE TO WEIGHT BEAR ON AFFECTED ANKLE|UNABLE TO WEIGHT BEAR ON AFFECTED FOOT"]
[text size="40"]

Palpation:
-[select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="distal fibula|anterior talofibular ligament (ATFL)|posterior talofibular ligament (PTFL)|calcaneal fibular ligament (CFL)|distal tibia/lateral malleolus|medial malleolus|deltoid ligament complex|base of 5th metatarsal|dorsal aspect of navicular bone|proximal fibula"].
[text size="40"]

ROM:
Ankle- [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension|ankle inversion|ankle everson"]
Foot- [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="hallux flexion|hallux extension|flexion of lesser toes|extension of lesser toes|foot inversion|foot everson"]
[text size="40"]

Special tests:
-Talar tilt test [select value="negative|POSITIVE"]
-Anterior drawer test [select value="negative|POSITIVE"]
-Squeeze test [select value="negative|POSITIVE"]
-Ankle External Rotation Test (Syndesmotic Stress Test) [select value="negative|POSITIVE"],Thompson test [select value="negative|POSITIVE"][text size="40"]
[/conditional][conditional field="Q2" condition="(Q2).is('Head and Face')"]
Power is [select name="variable_150" value="normal bilaterally|weak right side|weak left side"].Sensation to light touch is [select name="variable_151" value="intact|decreased over left side|decreased over right side"].there [select name="variable_152" value="is no|is"] hyperesthesia,hypoesthesia, allodynia. Palpation of TMJ region[select name="variable_4070" value=",|(is tender right side|is tender left side|is tender bilaterally"]supraorbital[select name="variable_4071" value=",|(is tender right side|is tender left side|is tender bilaterally"]infraorbital[select name="variable_4072" value=",|(is tender right side|is tender left side|is tender bilaterally"]temporal area[select name="variable_4073" value=",|(is tender right side|is tender left side|is tender bilaterally"]lesser and greater occipital nerve region[select name="variable_4074" value=",|(is tender right side|is tender left side|is tender bilaterally"]Splenius Capitus[select name="variable_4075" value=",|(is tender right side|is tender left side|is tender bilaterally"]sternocleidomastoid[select name="variable_4075" value=",|(is tender right side|is tender left side|is tender bilaterally"] [select name="variable_154" value="are non tender.|."] There is no evidence of bruxism.[text name="variable_155" default=""]
[comment memo="Adapted from content on https://fpnotebook.com/Ortho/Exam/AnklExm.htm"][/conditional]

[select name="Q3" value="|Head and Face|Neck|Upper Back|Low Back|R/L Shoulder|R/L Elbow|R/L Wrist|R/L Hip|R/L Knee|R/L Ankle/Foot"][conditional field="Q3" condition="(Q3).is('Neck')"]
Inspection of the neck and cervical spine [select name="variable_746" value="there is no|there is"] signs of muscle spasm,
muscle wasting, skin changes [text name="variable_747" default="."]
[select name="variable_745" value="There is no tenderness over cervical spinous process and paraspinous muscles.| There is tenderness over spinous process and paraspinous muscles.|There is tenderness over spinous process|There is tenderness over paraspinous muscles."] [text name="variable_748" default=""]
Forward flexion [select name="variable_1799" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain on movement,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|decreased severely,"]Extension [select name="variable_1798" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain on movement,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|decreased severely,"]Left Lateral bending [select name="variable_1797" value="|Full,|Normal but patient reports pain,|Decreased and patient reports pain on movement,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|decreased severely,"]Right Lateral bending [select name="variable_1796" value="|Full,|Normal but patient reports pain,|Decreased and patient reports pain on movement,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|decreased severely,"] [select name="variable_4080" value="are within acceptable ranges and not causing pain.|."]
Strength checked with resisted internal rotation, external rotation,resisted flexion and extension [select name="variable_767" value="were within normal limits|revealed weakness over"] [text name="variable_768" default=""]
Spurling test [select name="variable_760" value=",|was negative|was positive|caused pain|caused pain over right side|caused pain over left side"]Cervical compression test [select name="variable_761" value=" |elicit pain|caused pain|was negative|was positive"][select name="variable_4081" value="were negative| "]
Light touch of face and neck [select name="variable_762" value="did not reveal|showed"] allodynia , hypoesthesia.
[/conditional][conditional field="Q3" condition="(Q3).is('R/L Shoulder')"]
Inspection of both exposed shoulders from front and back, there [select name="variable_156" value="is no|is"] asymmetry, atrophy, swelling, ecchymosis, venous distention.[text name="variable_158" default=""]Apprehension test for shoulder stability was [select name="variable_159" value="negative bilaterally|positive right side|positive left side"]. Palpation of sternoclavicular joint[select name="variable_4050" value=",|(is tender),|(is mildly tender),"]clavicle[select name="variable_4051" value=",|(is tender),|(is mildly tender),"]AC joint[select name="variable_4052" value=",|(is tender),|(is mildly tender),"]bicipital groove[select name="variable_4053" value=",|(is tender),|(is mildly tender),"]glenohumeral joint[select name="variable_4055" value=",|(is tender),|(is mildly tender),"]anterior subacromial space[select name="variable_4056" value=",|(is tender),|(is mildly tender),"]posterior subacromial space[select name="variable_4057" value=",|(is tender),|(is mildly tender),"]rotator cuff tendons [select name="variable_161" value="did not elicit tenderness|caused tenderness over|."][text name="variable_691" default=""]
There [select name="variable_162" value="is no tenderness over the spinous process and paraspinous muscles.|is tenderness over the spinous process.|is tenderness over the paraspinous muscles."]
Range of motion performed actively and passively in forward flexion [select name="variable_165" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]extension [select name="variable_166" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]abduction[select name="variable_177" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]external rotation[select name="variable_167" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]internal rotation[select name="variable_168" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]horizontal abduction[select name="variable_169" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"] [select name="variable_4060" value="are within acceptable ranges|are within normal limits|."] [text name="variable_4061" default=""]
Strength checked with resisted internal rotation, external rotation, resisted abduction and adduction are [select name="variable_170" value="within normal limits|revealed weakness of"] [text name="variable_171" default=""]
Speed test [select name="variable_172" value=",|was negative bilaterally|was positive bilaterally|was positive over right shoulder|was positive over left shoulder"] Neer's test [select name="variable_173" value=",|was negative bilaterally|was positive bilaterally|was positive over right shoulder|was positive over left shoulder "] Labrum grind test [select name="variable_174" value=" were negative bilaterally|was positive bilaterally|was positive over right shoulder|was positive over left shoulder "].[text name="variable_3002" default=""]
[/conditional][conditional field="Q3" condition="(Q3).is('R/L Elbow')"]
Inspection: [checkbox value="No gross deformity|EDEMA|EFFUSION|ECCHYMOSIS"]. [text size="30"]

Palpation: [select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="olecranon|antecubital fossa|medial epicondyle|lateral epicondyle"]. [text size="40"]

ROM: [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension"]
[text size="50"][/conditional][conditional field="Q3" condition="(Q3).is('R/L Wrist')"]
Inspection: [select value="No gross deformity|GROSS DEFORMITY-"] [text size="30"]

Palpation: [select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="dorsal aspect|volar aspect|medial aspect|lateral aspect"]. [text size="40"]

ROM: [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension|abduction/adduction"]. [text size="40"]

Special tests:
-Tinel's test [select value="negative|POSITIVE"]
-Phalen's test [select value="negative|POSITIVE"]
-Reverse phalen's test [select value="negative|POSITVE"]
-Finklestein's test [select value="negative|POSITVE"]
[text size="50"][/conditional][conditional field="Q3” condition="(Q3).is('Upper Back')"]
Inspection:
-[checkbox value="No gross deformity|LEFT-SIDED PARASPINAL MUSCLE SPASM|RIGHT-SIDED PARASPINAL MUSCLE SPASM|GROSS/EXCESS LATERAL SPINAL CURVATURE|R SCAPULAR WINGING|L SCAPULAR WINGING"]. [text size="30"]
-[checkbox value="No gait abnormalities|ANTALGIC GAIT|TRENDELENBURG GAIT"].

Palpation:
-[select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="R 1st rib|L 1st rib|R paraspinals|L paraspinals|midline/spinous processes|R upper trapezius|L upper trapezius|R lower trapezius|L lower trapezius"].
-[select value="No step-offs noted|ABNORMAL STEP-OFF NOTED-"] [text size="40"]

ROM: Thoracolumbar [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension|right side-bend|left side-bend|right rotation|left rotation"]. [text size="40"]

Special tests:
-Spurling's test [select value="negative b/l|R POSITIVE|L POSITIVE"].
-Axial compression test [select value="negative|POSITIVE"]
[text size="50"][/conditional][conditional field="Q3" condition="(Q3).is('Low Back')"]
Inspection of entire back [select name="variable_1790" value="Did not show any|showed"] redness, asymmetry, deformity, scoliosis, hair growth and Step off deformity[text name="variable_18" default="."]
Palpation of Spinous process [select name="variable_9004" value=",|is tender,"]Paraspinous muscles[select name="variable_9005" value=",|is tender,"]Sacroiliac joints[select name="variable_4006" value=",|is tender,"]Tip of coccyx[select name="variable_4007" value=",|is tender,"]paravertebral muscles[select name="variable_4008" value=",|is tender,"] [select name="variable_4009" value="are non tender|.|mildly tender"]. [text name="variable_4010" default=""]
Range of motion in Forward flexion [select name="variable_4011" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|severely reduced,"]Extension [select name="variable_4012" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|severely reduced,"]Lateral bendings[select name="variable_4013" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|severely reduced,"]Twisting [select name="variable_4014" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|severely reduced,"] [select name="variable_4015" value="are within acceptable ranges.|are within normal limits.|."][text name="variable_4016" default=""]
Strength testing on Heel walking[select name="variable_4017" value=",|show bilateral weakness|weakness over right side|weakness over left side"]sideToe walking[select name="variable_4018" value=",|show bilateral weakness|weakness over right side|weakness over left side"]Resisted great toe dorsiflexion [select name="variable_4018" value=",|show bilateral weakness|weakness over right side|weakness over left side"] [select name="variable_4019" value="did not show signs of weakness bilaterally.|."][text name="variable_4020" default=""]
Deep tendon reflexes over knee and ankle [select name="variable_1882" value="2+ and symetric|1+ and symetric|weak bilateraly"]. Straight-leg raise [checkbox name="variable_1881" value="Positive less than 60 degree|Positive between 60 and 90 degrees|Negative"] [select name="variable_1880" value="Bilaterally|Left side|Right side"] [text name="variable_674" default=""]
Dorsiflexion of ankle during straight-leg raise test [select name="variable_1879" value="did not Increased|increased"] sciatic tension and pain [select name="variable_1878" value="Bilaterally|over right side|Over left side"]. Ankle clonus was negative, Negative babinsky sign.
Sensation over L4, L5, S1, Obturator and Femoral nerve distributions [select name="variable_1850" value="are within normal limits|showed decreased sensation over"] [text name="variable_1877" default=""]. There [select name="variable_1876" value="is no|is"] allodynia, Hypoesthesia or Hyperesthesia over lower extremities.
Distal pulses of dorsalis pedis and posterior tibialis [select name="variable_1875" value="are palpable|palpable but weak|barely palpable|are not palpable"] [text name="variable_3004" default=""]
Special tests:
Patrick test [select name="variable_1874" value="Did not elicit|elicited"] SI joint/Groin pain [select name="variable_887" value="bilaterally|over left side|over right side"]. Stork test [select name="variable_1849" value="Did not|Did"] elicits lower back pain [select name="variable_888" value="bilaterally|over left side|over right side"] [text name="variable_3004" default=""]
[/conditional][conditional field="Q3" condition="(Q3).is('R/L Hip')"]
Hip Exam
Inspection of hip from front and back [select name="variable_901" value="had no asymmetry,atrophy or pelvic tilt|some asymmetry noted over|atrophy noted over|asymmetry and atrophy noted over"] [text name="variable_902" default=""]
Palpation of Anterior hip joint[select name="variable_4090" value=",|(caused pain over right side|(caused pain over left side)"]anterior superior iliac spine[select name="variable_4091" value=",|(caused pain over right side|(caused pain over left side)"]anterior inferior iliac spine[select name="variable_4092" value=",|(caused pain over right side|(caused pain over left side)"]greater trochanter[select name="variable_4093" value=",|(caused pain over right side|(caused pain over left side)"]iliotibial band[select name="variable_4094" value=",|(caused pain over right side|(caused pain over left side)"]gluteus muscle area[select name="variable_4095" value=",|(caused pain over right side|(caused pain over left side)"]Ischial bursa[select name="variable_4096" value=",|(caused pain over right side|(caused pain over left side)"]Trochanteric bursa[select name="variable_4097" value=",|(caused pain over right side|(caused pain over left side)"]SI joint[select name="variable_4098" value=",|(caused pain over right side|(caused pain over left side)"][select name="variable_904" value="did not ilicit tenderness|caused tenderness over|were not tender but patient reported pain on deep palpation of"] [text name="variable_905" default=""]
Range of motion with Internal rotation [select name="variable_906" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]external rotation [select name="variable_907" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]flexion[select name="variable_908" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]extension [select name="variable_909" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]abduction[select name="variable_910" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]adduction[select name="variable_911" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"] [select name="variable_4099" value="are in acceptable ranges and do not cause pain on movements.| "]
[text name="variable_914" default=""]strengths examination [select name="variable_912" value="within normal limits bilaterally|revealed weakness bilaterally|revealed weakness left side|revealed weakness right side"]. [text name="variable_915" default=""]
Light touch [select name="variable_913" value="did not|did"] elicit hyperesthesia or allodynia.
Sensation over lateral thigh and medial thigh [select name="variable_917" value="were normal|were absent|slightly decreased"]. [text name="variable_918" default=""]
Trendelenburg test [select name="variable_919" value="did not|did"] elicit pelvic tilt, weakness or pain.
[text name="variable_920" default=""]. Logroll test negative.[text name="variable_1441" default=""]
[/conditional][conditional field="Q3" condition="(Q3).is('R/L Knee')"]
Inspection:
-[checkbox value="No gross deformity|GROSS EFFUSION|ECCHYMOSIS|LATERALLY DISPLACED PATELLA"][text size="30"]
-[select value="No gait abnormalities|GAIT ABNORMALITIES"] - [checkbox value="VARUS THRUST|ANTALGIC|LATERAL PATELLAR TRACKING|FLEXED KNEE GAIT"]
[text size="40"]

Palpation:
-[select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="Patellar tendon|Medial Joint Line|Lateral Joint Line|Pes Anserine Bursa|Quad tendon|IT Band|LCL Ligament|MCL Ligament|Popliteal Fossa"].
-[select value="No palpable baker's cyst|PALPABLE BAKER'S CYST"].
[text size="40"]

ROM: [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension|internal rotation|external rotation"]
[text size="40"]

Special tests:
-Patellar apprehenson test [select value="negative|POSITIVE"]
-Varus test [select value="negative|POSITIVE"]
-Valgus test [select value="negative|POSITIVE"]
-Lachman's test [select value="negative|POSITIVE"]
-Anterior drawer test [select value="negative|POSITIVE"]
-Posterior drawer test [select value="negative|POSITIVE"]
-McMurray's test [select value="negative|POSITIVE"]
-Thessaly test [select value="negative|POSITIVE"]
[text area][/conditional][conditional field="Q3" condition="(Q3).is('R/L Ankle/Foot')"]
Inspection:
-Ankle- [checkbox value="No gross deformity|GROSS EFFUSION|ECCHYMOSIS|GROSS DISLOCATION"][text size="30"]
-Foot- [checkbox value="Normal height of plantar arches with weight bearing|HIGH ARCHES with weight bearing|REDUCED PLANTAR ARCH HEIGHTS with weight bearing|COMPLETE COLLAPSE OF PLANTAR ARCHES with weight bearing|R Hallux Valgus|L Hallux Valgus|Unable to assess d/t distracting pain"]
-[select value="No gait abnormalities|GAIT ABNORMALITIES-"] [checkbox value="ANTALGIC but able to bear weight|UNABLE TO WEIGHT BEAR ON AFFECTED ANKLE|UNABLE TO WEIGHT BEAR ON AFFECTED FOOT"]
[text size="40"]

Palpation:
-[select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="distal fibula|anterior talofibular ligament (ATFL)|posterior talofibular ligament (PTFL)|calcaneal fibular ligament (CFL)|distal tibia/lateral malleolus|medial malleolus|deltoid ligament complex|base of 5th metatarsal|dorsal aspect of navicular bone|proximal fibula"].
[text size="40"]

ROM:
Ankle- [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension|ankle inversion|ankle everson"]
Foot- [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="hallux flexion|hallux extension|flexion of lesser toes|extension of lesser toes|foot inversion|foot everson"]
[text size="40"]

Special tests:
-Talar tilt test [select value="negative|POSITIVE"]
-Anterior drawer test [select value="negative|POSITIVE"]
-Squeeze test [select value="negative|POSITIVE"]
-Ankle External Rotation Test (Syndesmotic Stress Test) [select value="negative|POSITIVE"], Thompson test [select value="negative|POSITIVE"]text size="40"]
[/conditional][conditional field="Q3" condition="(Q3).is('Head and Face')"]
Power is [select name="variable_150" value="normal bilaterally|weak right side|weak left side"].Sensation to light touch is [select name="variable_151" value="intact|decreased over left side|decreased over right side"].there [select name="variable_152" value="is no|is"] hyperesthesia,hypoesthesia, allodynia. Palpation of TMJ region[select name="variable_4070" value=",|(is tender right side|is tender left side|is tender bilaterally"]supraorbital[select name="variable_4071" value=",|(is tender right side|is tender left side|is tender bilaterally"]infraorbital[select name="variable_4072" value=",|(is tender right side|is tender left side|is tender bilaterally"]temporal area[select name="variable_4073" value=",|(is tender right side|is tender left side|is tender bilaterally"]lesser and greater occipital nerve region[select name="variable_4074" value=",|(is tender right side|is tender left side|is tender bilaterally"]Splenius Capitus[select name="variable_4075" value=",|(is tender right side|is tender left side|is tender bilaterally"]sternocleidomastoid[select name="variable_4075" value=",|(is tender right side|is tender left side|is tender bilaterally"] [select name="variable_154" value="are non tender.|."] There is no evidence of bruxism.[text name="variable_155" default=""]
[comment memo="Adapted from content on https://fpnotebook.com/Ortho/Exam/AnklExm.htm"][/conditional]

[select name="Q5" value="|Head and Face|Neck|Upper Back|Low Back|R/L Shoulder|R/L Elbow|R/L Wrist|R/L Hip|R/L Knee|R/L Ankle/Foot"][conditional field="Q5" condition="(Q5).is('Neck')"]
Inspection of the neck and cervical spine [select name="variable_746" value="there is no|there is"] signs of muscle spasm,
muscle wasting, skin changes [text name="variable_747" default="."]
[select name="variable_745" value="There is no tenderness over cervical spinous process and paraspinous muscles.| There is tenderness over spinous process and paraspinous muscles.|There is tenderness over spinous process|There is tenderness over paraspinous muscles."] [text name="variable_748" default=""]
Forward flexion [select name="variable_1799" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain on movement,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|decreased severely,"]Extension [select name="variable_1798" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain on movement,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|decreased severely,"]Left Lateral bending [select name="variable_1797" value="|Full,|Normal but patient reports pain,|Decreased and patient reports pain on movement,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|decreased severely,"]Right Lateral bending [select name="variable_1796" value="|Full,|Normal but patient reports pain,|Decreased and patient reports pain on movement,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|decreased severely,"] [select name="variable_4080" value="are within acceptable ranges and not causing pain.|."]
Strength checked with resisted internal rotation, external rotation,resisted flexion and extension [select name="variable_767" value="were within normal limits|revealed weakness over"] [text name="variable_768" default=""]
Spurling test [select name="variable_760" value=",|was negative|was positive|caused pain|caused pain over right side|caused pain over left side"]Cervical compression test [select name="variable_761" value=" |elicit pain|caused pain|was negative|was positive"][select name="variable_4081" value="were negative| "]
Light touch of face and neck [select name="variable_762" value="did not reveal|showed"] allodynia , hypoesthesia.
[/conditional][conditional field="Q5" condition="(Q5).is('R/L Shoulder')"]
Inspection of both exposed shoulders from front and back, there [select name="variable_156" value="is no|is"] asymmetry, atrophy, swelling, ecchymosis, venous distention.[text name="variable_158" default=""]Apprehension test for shoulder stability was [select name="variable_159" value="negative bilaterally|positive right side|positive left side"]. Palpation of sternoclavicular joint[select name="variable_4050" value=",|(is tender),|(is mildly tender),"]clavicle[select name="variable_4051" value=",|(is tender),|(is mildly tender),"]AC joint[select name="variable_4052" value=",|(is tender),|(is mildly tender),"]bicipital groove[select name="variable_4053" value=",|(is tender),|(is mildly tender),"]glenohumeral joint[select name="variable_4055" value=",|(is tender),|(is mildly tender),"]anterior subacromial space[select name="variable_4056" value=",|(is tender),|(is mildly tender),"]posterior subacromial space[select name="variable_4057" value=",|(is tender),|(is mildly tender),"]rotator cuff tendons [select name="variable_161" value="did not elicit tenderness|caused tenderness over|."][text name="variable_691" default=""]
There [select name="variable_162" value="is no tenderness over the spinous process and paraspinous muscles.|is tenderness over the spinous process.|is tenderness over the paraspinous muscles."]
Range of motion performed actively and passively in forward flexion [select name="variable_165" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]extension [select name="variable_166" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]abduction[select name="variable_177" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]external rotation[select name="variable_167" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]internal rotation[select name="variable_168" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"]horizontal abduction[select name="variable_169" value=",|Full,|Normal but patient reports pain on movement,|Decreased and patient reports pain on movement,|Decreased about 10%-20%,|Decreased 20%,|Decreased about 30%-40%,|Decreased more than 30%,|severely effected,"] [select name="variable_4060" value="are within acceptable ranges|are within normal limits|."] [text name="variable_4061" default=""]
Strength checked with resisted internal rotation, external rotation, resisted abduction and adduction are [select name="variable_170" value="within normal limits|revealed weakness of"] [text name="variable_171" default=""]
Speed test [select name="variable_172" value=",|was negative bilaterally|was positive bilaterally|was positive over right shoulder|was positive over left shoulder"] Neer's test [select name="variable_173" value=",|was negative bilaterally|was positive bilaterally|was positive over right shoulder|was positive over left shoulder "] Labrum grind test [select name="variable_174" value=" were negative bilaterally|was positive bilaterally|was positive over right shoulder|was positive over left shoulder "].[text name="variable_3002" default=""]
[/conditional][conditional field="Q5" condition="(Q5).is('R/L Elbow')"]
Inspection: [checkbox value="No gross deformity|EDEMA|EFFUSION|ECCHYMOSIS"]. [text size="30"]

Palpation: [select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="olecranon|antecubital fossa|medial epicondyle|lateral epicondyle"]. [text size="40"]

ROM: [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension"]
[text size="50"][/conditional][conditional field="Q5" condition="(Q5).is('R/L Wrist')"]
Inspection: [select value="No gross deformity|GROSS DEFORMITY-"] [text size="30"]

Palpation: [select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="dorsal aspect|volar aspect|medial aspect|lateral aspect"]. [text size="40"]

ROM: [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension|abduction/adduction"]. [text size="40"]

Special tests:
-Tinel's test [select value="negative|POSITIVE"]
-Phalen's test [select value="negative|POSITIVE"]
-Reverse phalen's test [select value="negative|POSITVE"]
-Finklestein's test [select value="negative|POSITVE"]
[text size="50"][/conditional][conditional field="Q5” condition="(Q5).is('Upper Back')"]
Inspection:
-[checkbox value="No gross deformity|LEFT-SIDED PARASPINAL MUSCLE SPASM|RIGHT-SIDED PARASPINAL MUSCLE SPASM|GROSS/EXCESS LATERAL SPINAL CURVATURE|R SCAPULAR WINGING|L SCAPULAR WINGING"]. [text size="30"]
-[checkbox value="No gait abnormalities|ANTALGIC GAIT|TRENDELENBURG GAIT"].

Palpation:
-[select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="R 1st rib|L 1st rib|R paraspinals|L paraspinals|midline/spinous processes|R upper trapezius|L upper trapezius|R lower trapezius|L lower trapezius"].
-[select value="No step-offs noted|ABNORMAL STEP-OFF NOTED-"] [text size="40"]

ROM: Thoracolumbar [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension|right side-bend|left side-bend|right rotation|left rotation"]. [text size="40"]

Special tests:
-Spurling's test [select value="negative b/l|R POSITIVE|L POSITIVE"].
-Axial compression test [select value="negative|POSITIVE"]
[text size="50"][/conditional][conditional field="Q5" condition="(Q5).is('Low Back')"]
Inspection of entire back [select name="variable_1790" value="Did not show any|showed"] redness, asymmetry, deformity, scoliosis, hair growth and Step off deformity[text name="variable_18" default="."]
Palpation of Spinous process [select name="variable_9004" value=",|is tender,"]Paraspinous muscles[select name="variable_9005" value=",|is tender,"]Sacroiliac joints[select name="variable_4006" value=",|is tender,"]Tip of coccyx[select name="variable_4007" value=",|is tender,"]paravertebral muscles[select name="variable_4008" value=",|is tender,"] [select name="variable_4009" value="are non tender|.|mildly tender"]. [text name="variable_4010" default=""]
Range of motion in Forward flexion [select name="variable_4011" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|severely reduced,"]Extension [select name="variable_4012" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|severely reduced,"]Lateral bendings[select name="variable_4013" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|severely reduced,"]Twisting [select name="variable_4014" value=",|Full,|Normal but patient reports pain,|Decreased and patient reports pain,|Decreased 10%,|Decreased 20%,|Decreased 30%,|Decreased more than 30%,|severely reduced,"] [select name="variable_4015" value="are within acceptable ranges.|are within normal limits.|."][text name="variable_4016" default=""]
Strength testing on Heel walking[select name="variable_4017" value=",|show bilateral weakness|weakness over right side|weakness over left side"]sideToe walking[select name="variable_4018" value=",|show bilateral weakness|weakness over right side|weakness over left side"]Resisted great toe dorsiflexion [select name="variable_4018" value=",|show bilateral weakness|weakness over right side|weakness over left side"] [select name="variable_4019" value="did not show signs of weakness bilaterally.|."][text name="variable_4020" default=""]
Deep tendon reflexes over knee and ankle [select name="variable_1882" value="2+ and symetric|1+ and symetric|weak bilateraly"]. Straight-leg raise [checkbox name="variable_1881" value="Positive less than 60 degree|Positive between 60 and 90 degrees|Negative"] [select name="variable_1880" value="Bilaterally|Left side|Right side"] [text name="variable_674" default=""]
Dorsiflexion of ankle during straight-leg raise test [select name="variable_1879" value="did not Increased|increased"] sciatic tension and pain [select name="variable_1878" value="Bilaterally|over right side|Over left side"]. Ankle clonus was negative, Negative babinsky sign.
Sensation over L4, L5, S1, Obturator and Femoral nerve distributions [select name="variable_1850" value="are within normal limits|showed decreased sensation over"] [text name="variable_1877" default=""]. There [select name="variable_1876" value="is no|is"] allodynia, Hypoesthesia or Hyperesthesia over lower extremities.
Distal pulses of dorsalis pedis and posterior tibialis [select name="variable_1875" value="are palpable|palpable but weak|barely palpable|are not palpable"] [text name="variable_3004" default=""]
Special tests:
Patrick test [select name="variable_1874" value="Did not elicit|elicited"] SI joint/Groin pain [select name="variable_887" value="bilaterally|over left side|over right side"]. Stork test [select name="variable_1849" value="Did not|Did"] elicits lower back pain [select name="variable_888" value="bilaterally|over left side|over right side"] [text name="variable_3004" default=""]
[/conditional][conditional field="Q5" condition="(Q5).is('R/L Hip')"]
Hip Exam
Inspection of hip from front and back [select name="variable_901" value="had no asymmetry,atrophy or pelvic tilt|some asymmetry noted over|atrophy noted over|asymmetry and atrophy noted over"] [text name="variable_902" default=""]
Palpation of Anterior hip joint[select name="variable_4090" value=",|(caused pain over right side|(caused pain over left side)"]anterior superior iliac spine[select name="variable_4091" value=",|(caused pain over right side|(caused pain over left side)"]anterior inferior iliac spine[select name="variable_4092" value=",|(caused pain over right side|(caused pain over left side)"]greater trochanter[select name="variable_4093" value=",|(caused pain over right side|(caused pain over left side)"]iliotibial band[select name="variable_4094" value=",|(caused pain over right side|(caused pain over left side)"]gluteus muscle area[select name="variable_4095" value=",|(caused pain over right side|(caused pain over left side)"]Ischial bursa[select name="variable_4096" value=",|(caused pain over right side|(caused pain over left side)"]Trochanteric bursa[select name="variable_4097" value=",|(caused pain over right side|(caused pain over left side)"]SI joint[select name="variable_4098" value=",|(caused pain over right side|(caused pain over left side)"][select name="variable_904" value="did not ilicit tenderness|caused tenderness over|were not tender but patient reported pain on deep palpation of"] [text name="variable_905" default=""]
Range of motion with Internal rotation [select name="variable_906" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]external rotation [select name="variable_907" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]flexion[select name="variable_908" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]extension [select name="variable_909" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]abduction[select name="variable_910" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"]adduction[select name="variable_911" value=",|Full|Normal but patient reports pain on movement|Decreased and patient reports pain on movement|Decreased about 10%-20%|Decreased 20%|Decreased about 30%-40%|Decreased more than 30%|reduced severely"] [select name="variable_4099" value="are in acceptable ranges and do not cause pain on movements.| "]
[text name="variable_914" default=""]strengths examination [select name="variable_912" value="within normal limits bilaterally|revealed weakness bilaterally|revealed weakness left side|revealed weakness right side"]. [text name="variable_915" default=""]
Light touch [select name="variable_913" value="did not|did"] elicit hyperesthesia or allodynia.
Sensation over lateral thigh and medial thigh [select name="variable_917" value="were normal|were absent|slightly decreased"]. [text name="variable_918" default=""]
Trendelenburg test [select name="variable_919" value="did not|did"] elicit pelvic tilt, weakness or pain.
[text name="variable_920" default=""]. Logroll test negative.[text name="variable_1441" default=""]
[/conditional][conditional field="Q5" condition="(Q5).is('R/L Knee')"]
Inspection:
-[checkbox value="No gross deformity|GROSS EFFUSION|ECCHYMOSIS|LATERALLY DISPLACED PATELLA"][text size="30"]
-[select value="No gait abnormalities|GAIT ABNORMALITIES"] - [checkbox value="VARUS THRUST|ANTALGIC|LATERAL PATELLAR TRACKING|FLEXED KNEE GAIT"]
[text size="40"]

Palpation:
-[select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="Patellar tendon|Medial Joint Line|Lateral Joint Line|Pes Anserine Bursa|Quad tendon|IT Band|LCL Ligament|MCL Ligament|Popliteal Fossa"].
-[select value="No palpable baker's cyst|PALPABLE BAKER'S CYST"].
[text size="40"]

ROM: [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension|internal rotation|external rotation"]
[text size="40"]

Special tests:
-Patellar apprehenson test [select value="negative|POSITIVE"]
-Varus test [select value="negative|POSITIVE"]
-Valgus test [select value="negative|POSITIVE"]
-Lachman's test [select value="negative|POSITIVE"]
-Anterior drawer test [select value="negative|POSITIVE"]
-Posterior drawer test [select value="negative|POSITIVE"]
-McMurray's test [select value="negative|POSITIVE"]
-Thessaly test [select value="negative|POSITIVE"]
[text area][/conditional][conditional field="Q5" condition="(Q5).is('R/L Ankle/Foot')"]
Inspection:
-Ankle- [checkbox value="No gross deformity|GROSS EFFUSION|ECCHYMOSIS|GROSS DISLOCATION"][text size="30"]
-Foot- [checkbox value="Normal height of plantar arches with weight bearing|HIGH ARCHES with weight bearing|REDUCED PLANTAR ARCH HEIGHTS with weight bearing|COMPLETE COLLAPSE OF PLANTAR ARCHES with weight bearing|R Hallux Valgus|L Hallux Valgus|Unable to assess d/t distracting pain"]
-[select value="No gait abnormalities|GAIT ABNORMALITIES-"] [checkbox value="ANTALGIC but able to bear weight|UNABLE TO WEIGHT BEAR ON AFFECTED ANKLE|UNABLE TO WEIGHT BEAR ON AFFECTED FOOT"]
[text size="40"]

Palpation:
-[select value="No tenderness|TENDERNESS"] to palpation over [checkbox value="distal fibula|anterior talofibular ligament (ATFL)|posterior talofibular ligament (PTFL)|calcaneal fibular ligament (CFL)|distal tibia/lateral malleolus|medial malleolus|deltoid ligament complex|base of 5th metatarsal|dorsal aspect of navicular bone|proximal fibula"].
[text size="40"]

ROM:
Ankle- [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="flexion|extension|ankle inversion|ankle everson"]
Foot- [select value="Not limited & not painful|LIMITED and PAINFUL"] in [checkbox value="hallux flexion|hallux extension|flexion of lesser toes|extension of lesser toes|foot inversion|foot everson"]
[text size="40"]

Special tests:
-Talar tilt test [select value="negative|POSITIVE"]
-Anterior drawer test [select value="negative|POSITIVE"]
-Squeeze test [select value="negative|POSITIVE"]
-Ankle External Rotation Test (Syndesmotic Stress Test) [select value="negative|POSITIVE"], Thompson test [select value="negative|POSITIVE"]
[/conditional][conditional field="Q5" condition="(Q5).is('Head and Face')"] Power is [select name="variable_150" value="normal bilaterally|weak right side|weak left side"].Sensation to light touch is [select name="variable_151" value="intact|decreased over left side|decreased over right side"].there [select name="variable_152" value="is no|is"] hyperesthesia,hypoesthesia, allodynia. Palpation of TMJ region[select name="variable_4070" value=",|(is tender right side|is tender left side|is tender bilaterally"]supraorbital[select name="variable_4071" value=",|(is tender right side|is tender left side|is tender bilaterally"]infraorbital[select name="variable_4072" value=",|(is tender right side|is tender left side|is tender bilaterally"]temporal area[select name="variable_4073" value=",|(is tender right side|is tender left side|is tender bilaterally"]lesser and greater occipital nerve region[select name="variable_4074" value=",|(is tender right side|is tender left side|is tender bilaterally"]Splenius Capitus[select name="variable_4075" value=",|(is tender right side|is tender left side|is tender bilaterally"]sternocleidomastoid[select name="variable_4075" value=",|(is tender right side|is tender left side|is tender bilaterally"] [select name="variable_154" value="are non tender.|."] There is no evidence of bruxism.[text name="variable_155" default=""]
[text size="40"][comment memo="Adapted from content on https://fpnotebook.com/Ortho/Exam/AnklExm.htm"][/conditional]

[select name="Q1" value="|Head and Face|Neck|Upper Back|Low Back|R/L Shoulder|R/L Elbow|R/L Wrist|R/L Hip|R/L Knee|R/L Ankle/Foot"][conditional field="Q1" condition="(Q1).is('Neck')"]