PCC NOTE ed

Dear Dr. [text name="variable_1234567" default=""],
Thank you for referring this interesting [text name="variable_1234234" default=""] 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_2141234" default=""] to Pain Care Clinics at [select name="variable_7642" value="St. Catharines|Hamilton|Mississauga|Kitchener|Niagara Falls|Oakville"] on [date name="variable_2000" default=""] for chronic pain assessment and management. 

<b>HISTORY OF PRESENT ILLNESS</b>
Patient's main complaint is [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_1" default=""]. 
The 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=""]. There [select name="variable_1" value="was no preceding history of motor vehicle accidents, falls, or any other type of trauma|is a history of motor vehicle accident|is a history of a fall|there is a history of trauma"][textarea name="variable_001010" default=""]. [select name="variable_1732" value="He|She"] describes a [select name="constant" value="constant|intermittent|severe constant|on and off|insidious"] pain with character of [checkbox name="variable_1731" value="dull|achy|sharp|shooting|burning|tingling|itchy|cramping|numbness|coldness|stabbing|jabbing|pressure"] [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"]/10 at the best, [select name="variable_2729" value="0|1|2|3|4|5|6|7|8|9|10"]/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=""]

With respect to the patient's complaint of back pain, the patient reports no bowel or bladder dysfunction. There is no saddle anaesthesia weakness or radiation reported. No thoracic pain, fever, weight loss, night sweats, immunosuppression or history of carcinoma. The patient denies overt trauma, IV drug use, chronic steroid use or substantive night pain. 

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>
[textarea name="variable_1010109875" default=""]

<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"]
[textarea name="variable_172232" default=""]


<b>PAST SURGICAL HISTORY</b>
[textarea name="variable_1" default=""]

<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| Myocardial Infarction 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=""]
CT:
[textarea name="variable_28" default=""] 
MRI:
[textarea name="variable_29" default=""] 
U/S:
[textarea name="variable_30" default=""] 
Other:
[textarea name="variable_31" default=""]

<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"] 
[textarea name="variable_1236589" 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|Medical Cannabis inhalation|Cannabis Oil"]
[textarea name="variable_1123568" default=""]

<b>PAST THERAPIES</b>
[checkbox name="variable_20" value="No physical therapy has been done|Physiotherapy|Massage therapy|Chiropractic Treatment|Acupuncture|Thai Chi|Aquatic Therapy|Swimming|Cognitive Behavioral Therapy|Biofeedback|Hypnotic Therapy|Meditation and Mindfulness|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_100010" 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_20191" 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=""]. Their highest level of education is [select name="variable_10009099" value="High school diploma|College courses|College diploma|College Certificate|BA.|BSc.|BEng.|Masters Degree|PhD"]
[textarea name="variable_112312312312312" default=""]
Smoking: [select name="variable_128234" value="Non smoker|Ex-Smoker|Current smoker"] [text name="variable_140" default=""]
EtOH: [select name="variable_1998164" value="Not a drinker|Drinks Socially|Current drinker"] [text name="variable_139" default=""]
Recreational Drugs: [select name="variable_1131241" value="Denies|Uses socially|Current user"] [text name="variable_138" default=""]

<b>PSYCHOLOGICAL STATUS AND RELATED MATTERS</b>
The patient feels depressed and anxious at times, [select name="variable_1123123123123" value="however there is no overt history of depression or anxiety|there is a history of depression|there is a history of anxiety|there is a history of depression and anxiety"]. There is [select name="variable_789696" value="no history of suicidal ideation and the patient has had no previous suicide attempts|a history of suicidal ideation and the patient has had no previous suicide attempts|a history of suicidal ideation and the patient has had previous suicide attempts"]. The current suicide risk is [select name="variable_234234234234234234" value="low|medium|high"]. The patient [select name="variable_45754" value="does not|does"] see a psychiatrist. [text name="variable_23412341234123412341234" default=""]

<b>SLEEP</b>
Sleep is generally [select name="variable_1212678" value="refreshing|unrefreshing"]. [select name="variable_09838" value="There is latency in sleep onset regularly|There is latency in sleep onset sometimes|There is no latency in sleep onset"] with [select name="variable_0095272" value="no interruptions due to the pain|frequent interruptions due to the pain|interruptions due to the pain some nights"]. The patient reports awakening [select name="variable_123987234872595" value="every 1-2 hours|every 2-4 hours|every 4-6 hours|1-2 times|3-4 times|5-6 times|6-7 times"] per night. Medication [select name="variable_100984289" value="is|is not|sometimes"] utilized as a sleep aid. [text name="variable_18898" default=""]

<b>SEXUAL LIFE</b>
Sexual function is reportedly [select name="variable_88765" value="impaired|unimpaired"]. [select name="variable_8878" value="Both desire and physical ability are reduced by pain|Both desire and physical ability are reduced by medication side effects|Physical ability is reduced by pain|Desire and physical ability are reduced by pain|Both desire and physical ability are reduced by 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_0101" default=""]/24hr; [text name="variable_1012" default=""]/WEEK
4. Alcohol CAGE: [select name="variable_101234" value="NEGATIVE|POSITIVE"] 
5. Nicotine: [text name="variable_999" default=""]
6. Prescription drugs off the street? [select value= NO|YES]   Prescription drugs borrowed? [select value= NO|YES]
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]

UDS: 
[checklist name="variable_1" value="NEGATIVE|THC|MORPHINE|OXY|AMPHETAMINE|BENZO|HYDROMORPHONE"]

OPIATE RISK TOOL: [select name="variable_169696" value="Low|Medium|High"]

<b>PHYSICAL EXAMINATION</b> 

BP: [text name="variable_2121" default=""]|HR: [text name="variable_2122" default=""]|Height: [text name="variable_2123" default=""]cm |Weight: [text name="variable_2124" default=""]kg |BMI: [text name="variable_2125" 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|obese|frail"] and appears [select name="variable_39" value="well|poorly"] conditioned. Gait [select name="variable_40" value="is normal|is antalgic|is shuffling|is wide based|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. 
[select name="variable_1" value=" |They use a cane when walking.|They use a walker for assistance."] [text name="variable_300122" 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 are no|there are"] signs of muscle spasm, muscle wasting, skin changes [text name="variable_747" default="."]
Palpation: [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,|non-tender,"] clavicle [select name="variable_4051" value=",|is tender,|non-tender,"], AC joint [select name="variable_4052" value=",|is tender,|non-tender,"] bicipital groove [select name="variable_4053" value=",|is tender,|non-tender,"] glenohumeral joint [select name="variable_4055" value=",|is tender,|non-tender,"] anterior subacromial space [select name="variable_4056" value=",|is tender,|non-tender," ]posterior subacromial space [select name="variable_4057" value=",|is tender,|non-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 is [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|SHUFFLED GAIT|WIDE BASED 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,|non-tender," ]Paraspinous muscles [select name="variable_9005" value=",|is tender,|non-tender,"] Sacroiliac joints [select name="variable_4006" value=",|is tender,|non-tender,"] Tip of coccyx [select name="variable_4007" value=",|is tender,|non-tender,"] paravertebral muscles [select name="variable_4008" value=" |is tender,|non-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|weakness over left"] [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 symmetric|1+ and symmetric|weak bilaterally"]. 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 increase|increased"] sciatic tension and pain [select name="variable_1878" value="bilaterally|over right side|over left side"]. Ankle clonus was negative, Negative babinski sign.
Sensation over L4, L5, S1, Obturator and Femoral nerve distributions [select name="variable_1850" value="are within normal limits|showed decreased sensation over|decreased light touch and pin prick|decreased light touch|decreased pin prick"] [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,|non-tender," ]Paraspinous muscles [select name="variable_9005" value=",|is tender,|non-tender,"] Sacroiliac joints [select name="variable_4006" value=",|is tender,|non-tender,"] Tip of coccyx [select name="variable_4007" value=",|is tender,|non-tender,"] paravertebral muscles [select name="variable_4008" value=" |is tender,|non-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 symmetric|1+ and symmetric|weak bilaterally"]. 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 increase|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,|non-tender," ]Paraspinous muscles [select name="variable_9005" value=",|is tender,|non-tender,"] Sacroiliac joints [select name="variable_4006" value=",|is tender,|non-tender,"] Tip of coccyx [select name="variable_4007" value=",|is tender,|non-tender,"] paravertebral muscles [select name="variable_4008" value=" |is tender,|non-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 symmetric|1+ and symmetric|weak bilaterally"]. 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 increase|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|WIDE BASED GAIT|SHUFFLED 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,|is non tender,"] Paraspinous muscles [select name="variable_9005" value=",|is tender,|non-tender,"] Sacroiliac joints [select name="variable_4006" value=",|is tender,|non-tender,"] Tip of coccyx [select name="variable_4007" value=",|is tender,|non-tender"] paravertebral muscles [select name="variable_4008" value=",|is tender,|non-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 symmetric|1+ and symmetric|weak bilaterally"]. 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 Increase|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')"]

Yours Truly,
Asim Ansari

Dictating for __MD
Dear Dr. ,
Thank you for referring this interesting years old , to Pain Care Clinics at on for chronic pain assessment and management.

<b>HISTORY OF PRESENT ILLNESS</b>
Patient's main complaint is .
The pain started as patient explains due to . There
. describes a pain with character of .
The pain has a severity of /10 at the worse, /10 at the best, /10 on average and /10 at the moment.
The pain radiates to

Pain is exacerbated by and relieved with

With respect to the patient's complaint of back pain, the patient reports no bowel or bladder dysfunction. There is no saddle anaesthesia weakness or radiation reported. No thoracic pain, fever, weight loss, night sweats, immunosuppression or history of carcinoma. The patient denies overt trauma, IV drug use, chronic steroid use or substantive night pain.

DN4 Score
On an NRS scale the pain rating is at its worst, at best, on average it is and currently the pain is . Total BPI Interference Score is
Fibromyalgia Rapid Screening Tool: , for diagnosis of fibromyalgia.

<b>CONSULTATIONS</b>


<b>PAST MEDICAL HISTORY</b>




<b>PAST SURGICAL HISTORY</b>


<b>FAMILY HISTORY</b>


<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:

CT:

MRI:

U/S:

Other:


<b>PAST PAIN MEDICATIONS</b>



<b>CURRENT MEDICATIONS</b>



<b>PAST THERAPIES</b>



<b>ALLERGIES</b>
Patient and

<b>SOCIAL HISTORY</b>
Patient is currently , lives and has children . . Their highest level of education is

Smoking:
EtOH:
Recreational Drugs:

<b>PSYCHOLOGICAL STATUS AND RELATED MATTERS</b>
The patient feels depressed and anxious at times, . There is . The current suicide risk is . The patient see a psychiatrist.

<b>SLEEP</b>
Sleep is generally . with . The patient reports awakening per night. Medication utilized as a sleep aid.

<b>SEXUAL LIFE</b>
Sexual function is reportedly . .

<B>ADDICTION RISK</B>
1. Worsening AM pain?
2. Maximum EtOH: /24hr; /WEEK
4. Alcohol CAGE:
5. Nicotine:
6. Prescription drugs off the street? Prescription drugs borrowed?
7. Family psychiatric history
8. Family history of substance abuse
9. Personal history of trauma?
Personal history of emotional abuse?
Personal history of sexual abuse?
10. Personal history of substance abuse
11. Has the patient ever received treatment for drug abuse?

UDS:


OPIATE RISK TOOL:

<b>PHYSICAL EXAMINATION</b>

BP: |HR: |Height: cm |Weight: kg |BMI:


On physical exam today, I found the patient to be , oriented to person, place and time. The communication skills, recent and remote memory . insight and judgment, affect and mood appeared , was to follow commands and cooperated with the examination. Body Type is and appears conditioned. Gait with posture, has get up and go.


Systemic Examination:










Yours Truly,
Asim Ansari

Dictating for __MD

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.75, 948 form elements, 517 boilerplate words, 212 text boxes, 12 text areas, 1 dates, 90 checkboxes, 1 check lists, 587 drop downs, 4 comments, 41 conditionals, 1416 total clicks
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