Assessment & Plan Elements
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Subjective:
Thank you for referring this [select name="variable_2001" value="right-handed man|left-handed man|right-handed woman|left-handed woman"] , [select name="variable_1740" value="Mr.|Mrs."][text name="variable_2" default=""] to Pain Care Clinics at [select name="variable_7642" value="St. Catharines|Hamilton|Mississauga"] on [date name="variable_2000" default=""] with complaint of [checkbox name="variable_1739" value="Back Pain (Lower back)|Back Pain (upper back)|Headache|Neck pain|Shoulder (Bilateral) Pain|Shoulder Right Pain|Shoulder (left) Pain|Hand (Right) Hand Pain|Hand (left) pain|Hand (Bilateral) pain|Hip (Right) Pain|Hip (Left) pain|Hip (bilateral) Pain|Knee (Left) pain|Knee (Right) pain|Knee (Bilateral) Pain|Foot (right) pain|Foot (Left) pain|Foot (Bilateral) pain|Groin (right) pain|Groin (left) Pain|Groin (bilateral) pain"][text name="variable_1738" default=""]. [select name="variable_1737" value="His|Her"] main complaint is [select name="variable_1736" value="|Low Back Pain|Neck pain|Shoulder Pain|Right Hand Pain|Left hand pain|Right Hip Pain|Left Hip pain|Left Knee pain|Right Knee pain|Right Foot pain|Left foot pain|Left Groin pain|Right Groin Pain"]. [text name="variable_1735" default=""] .
Pain started [text name="variable_1734" default=""] [select name="variable_1733" value=" |years ago|months ago|weeks ago"] as patient explains due to [text name="variable_9" default=""]. [select name="variable_1732" value="He|She"] describes a [select name="constant" value="constant|intermittent|severe constant|Off and On"] pain with character of [checkbox name="variable_1731" value="Dull|Achy|Sharp|Shooting|Burning|Tingling|Itchy|Cramping|Numbness|coldness|stabbing|jabbing"] [text name="variable_1730" default=""]
with severity of [select name="variable_1729" value="0|1|2|3|4|5|6|7|8|9|10"]/10 at the worse and [select name="variable_2729" value="0|1|2|3|4|5|6|7|8|9|10"]/10 at the moment.
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 gets worse with [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 gets better 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=""]
Past Pain Medications:
[select name="variable_660" value="He|She"] [select name="variable_662" value="has tried|is taking|has not tried"] [checkbox name="variable_661" value="Tylenol|Different types of NSAIDS|Advil|Naproxen|Meloxicam|Gabapentin|Lyrica|Cymbalta|Elavil|Tramadol|Tylenol 1|Tylenol 2|Tylenol 3|Tylenol 4|Percocet|Hydromorphone IR|Hydromorphone CR|Dilaudid|Morphine IR|Morphine SR|Fentanyl patch|Suboxone|Medical cannabis inhalation|Cannabis Oil"]. [text name="variable_1720" default=""]
Current Pain Medications:
[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"]. [text name="variable_1721" default=""]
Past Physical Therapy: [checkbox name="variable_20" value="No physical therapy has been done|Physiotherapy|Massage therapy|Chiropractic Treatment|Accupuncture|Thai Chi|Aquatic Therapy|Swimming|Cognitive Behavioral Therapy|Biofeedback|Hypnotic Therapy|Meditation and Mindfullness|regular home exercises"]
[text name="variable_21" default=""]
Past Medical History:
[checkbox name="variable_1724" value="No significant past medical history reported by patient|Diabetes mellitus II| Hypertension| Dyslipidemia|Fibromyalgia| coronary artery disease| heart attack| cardiac arrhythmia| abdominal aortic aneurysm| colon cancer| prostate cancer| breast cancer| compression fracture over lumbar area| compression fracture over her thoracic area| compression fracture over cervical area|GERD|CHF| COPD|IBS|IBD|Asthma| chronic constipation| chronic diarrhea|depression|anxiety|psychosis|bipolar disorder|obsessive-compulsive disorder|personality disorder|ADHD|Autism"] [text name="variable_1723" default=""]
Allergies : 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 alleries.|has environmental allergies"] [text name="variable_3997" default=""]
Family History:
[checkbox name="variable_1722" value="No significant family history reported by patient|Diabetes mellitus II|Fibromyalgia| hypertension| dyslipidemia| coronary artery disease| heart attack at young age| cardiac arrhythmia| colon cancer| prostate cancer| breast cancer| compression fracture|Depression| anxiety| psychosis| bipolar disorder| obsessive-compulsive disorder| personality disorder| ADHD| autism"] [text name="variable_584" default=""]
Sleep:
[checkbox name="variable_153" value="Has no problem with sleeping| has problems with initiating sleep| has no problem with initiating sleep| has problem with maintaining sleep| has no problem with maintaining sleep| wakes up several times at night due to pain| takes medication to help with sleep"] [text name="variable_586" default=""]

Sexual life :
[checkbox name="variable_154" value="Has no problem with sexual life and is not concerned| Has problem with sexual life but is not concerned about this issue | has problem with desire in regards with sexual performance| has sexual problem in performance due to pain| has sexual problem due to medication side effects"]
[text name="variable_587" default=""]
Psychiatric History:
[select name="variable_4005" value="He|She"] [select name="variable_4001" value="has no psychiatric problem|has"] [checkbox name="variable_4004" value="Depression|Anxiety|Bipolar Disorder|OCD|Psychosis|Suicide attempt|Suicide thoughts|Personality Disorder|Addiction|Drug Dependence|PTSD"] [select name="variable_4002" value="and does not see a psychiatrist|sees a psychiatrist regularly|sees a psychatrist, last time had been|"] [text name="variable_4003" default=""]

Opioid Risk Tool

1. Gender
[select name="M1" value="Male|Female"][conditional field="M1" condition="(M1).is('Male')"]
2. Age
[select name="M4m" value="no=0|YES=1"] <-- 16-45 Years old (1 point)
3. Family history of substance abuse
[select name="M2m1" value="no=0|YES=3"] <-- Alcohol (3 points)
[select name="M2m2" value="no=0|YES=3"] <-- Illegal drugs (3 points)
[select name="M2m3" value="no=0|YES=4"] <-- Prescription drugs (4 points)
4. Personal history of substance abuse
[select name="M3m1" value="no=0|YES=3"] <-- Alcohol (3 points)
[select name="M3m2" value="no=0|YES=4"] <-- Illegal drugs (4 points)
[select name="M3m3" value="no=0|YES=5"] <-- Prescription drugs (5 points)
5. Psychological disease
[select name="M5m1" value="no=0|YES=2"] <-- ADHD/OCD/Schizophrenia/Bipolar (2 points)
[select name="M5m2" value="no=0|YES=1"] <-- Depression (1 point)
Score --> [calc memo="Score" value="score1=(M2m1)+(M2m2)+(M2m3)+(M3m1)+(M3m2)+(M3m3)+(M4m)+(M5m1)+(M5m2)"]
Interpretation --> [calc memo="Interpretation" value="score2=(M2m1)+(M2m2)+(M2m3)+(M3m1)+(M3m2)+(M3m3)+(M4m)+(M5m1)+(M5m2);score2>7?'High risk':score2>3?'Moderate risk':'Low risk'"][/conditional][conditional field="M1" condition="(M1).is('Female')"]
2. Age
[select name="M4f" value="no=0|YES=1"] <-- 16-45 Years old (1 point)
3. Family history of substance abuse
[select name="M2f1" value="no=0|YES=1"] <-- Alcohol (1 points)
[select name="M2f2" value="no=0|YES=2"] <-- Illegal drugs (2 points)
[select name="M2f3" value="no=0|YES=4"] <-- Prescription drugs (4 points)
4. Personal history of substance abuse
[select name="M3f1" value="no=0|YES=3"] <-- Alcohol (3 points)
[select name="M3f2" value="no=0|YES=4"] <-- Illegal drugs (4 points)
[select name="M3f3" value="no=0|YES=5"] <-- Prescription drugs (5 points)
[select name="M3f4" value="no=0|YES=3"] <-- Preadolescent sexual abuse (3 points)
5. Psychological disease
[select name="M5f1" value="no=0|YES=2"] <-- ADHD/OCD/Schizophrenia/Bipolar (2 points)
[select name="M5f2" value="no=0|YES=1"] <-- Depression (1 point)
Score --> [calc memo="Score" value="score3=(M2f1)+(M2f2)+(M2f3)+(M3f1)+(M3f2)+(M3f3)+(M3f4)+(M4f)+(M5f1)+(M5f2)"]
Interpretation --> [calc memo="Interpretation" value="score4=(M2f1)+(M2f2)+(M2f3)+(M3f1)+(M3f2)+(M3f3)+(M3f4)+(M4f)+(M5f1)+(M5f2);score4>7?'High risk':score4>3?'Moderate risk':'Low risk'"][/conditional]
[text name="variable_3000" default=""]

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

On Examination:
Afebrile, vitals in chart.
Not in acute distress, good eye contact, cooperative
PERRLA, no jaundice no pallor, no bruises, no ecchymosis, no cyanosis
Normal capillary refill.
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|poor"] oriented to person, place and time. [select name="variable_33" value="good|poor|needs help for"].
communication skills, recent and remote memory [select name="variable_34" value="are intact|are impaired|poor"].
[select name="variable_35" value="normal|poor"] insight and judgment, affect and mood appeared [select name="variable_36" value="congruent and within normal limits|non congruent|are congruent and down"], was [select name="variable_37" value="able|not able"] to follow commands and cooperated with the examination.
Body Type is [select name="variable_38" value="normal|slightly overweight|overweight|frail"] and appears [select name="variable_39" value="well|poor"] conditioned. Gait [select name="variable_40" value="is normal|anthalgic|is shuffling gait|is wide base gait| cannot be assessed|cannot be assessed, sits on wheelchair"] with [select name="variable_611" value="upright|mildly kyphotic|kyphotic|stooped forward"] posture, has [select name="variable_8463" value="normal|slow"] get up and go.[text name="variable_3001" default=""]
My objective findings as related to the injuries are as follows:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


IMPRESSION
1- [select name="variable_1442" value=" |Lumbar Degenerative Disk Disease|Right Sciatica Radiculopathy|Left Sciatica Radiculopathy|Bilateral Sciatica Radiculopathy|Lumbar Facet Joint Arthritis|Cervical Facet Joint Arthritis|Thoracic Facet Joint Arthritis|Sacroiliitis|Lumbar Spinal Stenosis|Thoracic Spinal Stenosis|Cervical Spinal Stenosis|Piriformis syndrome|Cervical Osteoarthritis|Cervical DDD|Cervical DDD with radiculopathy|Left shoulder osteoarthritis|Right shoulder Osreoarthritis|Bilateral shoulder osteoarthritis|Left rotator cuff injury|right rotator cuff injury|bilateral rotator cuff injury|Hip Osteoarthritis bilateral|Hip Osteoarthritis Left|Hip Osteoarthritis Right|Migraine Headache|Occipital Neuralgia|Right Carpal Tunnel Syndrome|Left Carpal Tunnel Syndrome|Bilateral Carpal Tunnel Syndrome|Neuropathic Pain"]
2- [select name="variable_1443" value=" |Lumbar Degenerative Disk Disease|Right Sciatica Radiculopathy|Left Sciatica Radiculopathy|Bilateral Sciatica Radiculopathy|Lumbar Facet Joint Arthritis|Cervical Facet Joint Arthritis|Thoracic Facet Joint Arthritis|Sacroiliitis|Lumbar Spinal Stenosis|Thoracic Spinal Stenosis|Cervical Spinal Stenosis|Piriformis syndrome|Cervical Osteoarthritis|Cervical DDD|Cervical DDD with radiculopathy|Left shoulder osteoarthritis|Right shoulder Osreoarthritis|Bilateral shoulder osteoarthritis|Left rotator cuff injury|right rotator cuff injury|bilateral rotator cuff injury|Hip Osteoarthritis bilateral|Hip Osteoarthritis Left|Hip Osteoarthritis Right|Migraine Headache|Occipital Neuralgia|Right Carpal Tunnel Syndrome|Left Carpal Tunnel Syndrome|Bilateral Carpal Tunnel Syndrome|Neuropathic Pain"]
3- [select name="variable_1444" value=" |Lumbar Degenerative Disk Disease|Right Sciatica Radiculopathy|Left Sciatica Radiculopathy|Bilateral Sciatica Radiculopathy|Lumbar Facet Joint Arthritis|Cervical Facet Joint Arthritis|Thoracic Facet Joint Arthritis|Sacroiliitis|Lumbar Spinal Stenosis|Thoracic Spinal Stenosis|Cervical Spinal Stenosis|Piriformis syndrome|Cervical Osteoarthritis|Cervical DDD|Cervical DDD with radiculopathy|Left shoulder osteoarthritis|Right shoulder Osreoarthritis|Bilateral shoulder osteoarthritis|Left rotator cuff injury|right rotator cuff injury|bilateral rotator cuff injury|Hip Osteoarthritis bilateral|Hip Osteoarthritis Left|Hip Osteoarthritis Right|Migraine Headache|Occipital Neuralgia|Right Carpal Tunnel Syndrome|Left Carpal Tunnel Syndrome|Bilateral Carpal Tunnel Syndrome|Neuropathic Pain"]
4- [select name="variable_1445" value=" |Lumbar Degenerative Disk Disease|Right Sciatica Radiculopathy|Left Sciatica Radiculopathy|Bilateral Sciatica Radiculopathy|Lumbar Facet Joint Arthritis|Cervical Facet Joint Arthritis|Thoracic Facet Joint Arthritis|Sacroiliitis|Lumbar Spinal Stenosis|Thoracic Spinal Stenosis|Cervical Spinal Stenosis|Piriformis syndrome|Cervical Osteoarthritis|Cervical DDD|Cervical DDD with radiculopathy|Left shoulder osteoarthritis|Right shoulder Osreoarthritis|Bilateral shoulder osteoarthritis|Left rotator cuff injury|right rotator cuff injury|bilateral rotator cuff injury|Hip Osteoarthritis bilateral|Hip Osteoarthritis Left|Hip Osteoarthritis Right|Migraine Headache|Occipital Neuralgia|Right Carpal Tunnel Syndrome|Left Carpal Tunnel Syndrome|Bilateral Carpal Tunnel Syndrome|Neuropathic Pain"]
5- [select name="variable_1446" value=" |Lumbar Degenerative Disk Disease|Right Sciatica Radiculopathy|Left Sciatica Radiculopathy|Bilateral Sciatica Radiculopathy|Lumbar Facet Joint Arthritis|Cervical Facet Joint Arthritis|Thoracic Facet Joint Arthritis|Sacroiliitis|Lumbar Spinal Stenosis|Thoracic Spinal Stenosis|Cervical Spinal Stenosis|Piriformis syndrome|Cervical DDD|Cervical DDD with radiculopathy|Left shoulder osteoarthritis|Right shoulder Osreoarthritis|Bilateral shoulder osteoarthritis|Left rotator cuff injury|right rotator cuff injury|bilateral rotator cuff injury|Hip Osteoarthritis bilateral|Hip Osteoarthritis Left|Hip Osteoarthritis Right|Migraine Headache|Occipital Neuralgia|Right Carpal Tunnel Syndrome|Left Carpal Tunnel Syndrome|Bilateral Carpal Tunnel Syndrome|Neuropathic Pain"]
[text name="variable_1447" default=""]

Treatment Plan:
Patient treatment is considered in three domains: interventional, pharmacological, and patient-centric recommendations. With this in mind the following recommendations are suggested:
Patient-centric Recommendations:
[text name="variable_670" default=""]
[select name="variable_680" value="He|She"] [select name="variable_681" value="has done|is doing|is going to do"]
[checkbox name="variable_671" value="No physical therapy|Physiotherapy|Massage therapy|Chiropractic therapy|Thai Chi exercises|Aquatic exercises|Yoga|Acupuncture|Tens Therapy|does exercises at home|We had a discussion about effects of physical therapy on pain management|and states none of them helped with pain|and states physical therapy gives temporary relief|.Patient cannot afford physical therapy due to financial limitations."]
[text name="variable_672" default=""]
[checkbox name="variable_614" value="Advised to increase physical activities.
Maintaining good posture and its effect on pain discussed. Discussed heat and ice, massage, postural exercises such as walking/swimming 3 times a week for at least 40 minutes, stretching and strengthening exercises and staying active.
|I recommended the patient to initiate a weight loss program and increase physical conditioning with an emphasis on core strength and gradual increase in exercise as tolerated. Commencing a wight loss program (weight watchers,Atkins diet...) offered to patient.|We also discussed about the fact that patients with chronic pain often try to protect the area that hurts by avoiding movements that exacerbates the pain and causes muscle atrophy, pain in tendons and connective tissue, loss of muscle strength and as a consequence there would be tendon and connective tissue pain. All this can be prevented with regular 20 minutes aerobic and 30 minutes weight bearing 5 days a week. I tried to encourage your patient to do more physical activities in spite of feeling pain.|I said we need to pump blood into the area that hurts and also pumping back to waste products that have been building up. Some patients do not need any medications or injections with just doing this.|We had a discussion about endurance of physical therapy as an important mainstays of this therapy. I also discussed about possible worsening of the pain at the beginning due to muscle weakness and is expected to get better with continuing of physical therapy.|I discussed about the importance of working on balance, stretching, range of motion and strengthening in physical therapy. Stretching by itself can lead to increase in range of motion and maintains functional ability. Yoga and tai-chi exercises are very good treatments to achieve these goals.|Therapeutic heat as it commonly used. Heat increases extensibility of collagen tissue decreases joint stiffness and improve muscle spasm on the other side stimulants more receptors and decreasing activation of nociceptors. It also increases blood flow which helps resolve the inflammatory infiltrate and edema. Aqua therapy exercises specifically in warm water has been reported by patients as a good approach for pain reduction. We have several sites for this aqua therapy both public and private in community.|Therapeutic massage which is often used for pain relief and in muscle relaxation. Massage releases muscle tension, promote relaxation, improving circulation and enhances tissue perfusion and oxygenation. This allows for the removal of lactic acid and other toxins from muscle tissue. Therapeutic massage may also help alleviate the pain caused by fibrous scar tissue.|Therapeutic ultrasound and TENS which has a mechanism of deep heating that leads to increased blood flow and reduction in muscle spasm, and increase extensibility of collagen fiber.|Acupuncture therapy works mostly on balancing energy and whole body. Research has shown that acupuncture releases endogenous opioids, and that the same opioid that are released with running. Acupuncture may also activate large myelinated fibers that causes inhibitory effects on pain.|Chronic Pain Self-Management program. This program is free of charge and runs two hours per week for six weeks. It focuses on assisting patients on improving self-awareness with pain perceptions and subsequent actions. Your patient has been given further information regarding the program. Hypnosis, mindfulness and meditation or other modalities of relaxation that helps to decrease the pain perceptions.|Cognitive behavioral therapy is also effective since pain is a complex experience that is influenced not only by its underlying pathophysiology but also by an individual's cognition. Cognitive behavioral therapy attempts to alter the psychological principles governing pain including patient’s beliefs, emotions, behavioral reactions and expectations. CBT is typically carried out in a small group sessions of 3-6 patients that are held weekly for 8-10 weeks. The group are typically led by a psychologist.|Biofeedback is a practice of providing information to the patient about unconscious physiologic processes such as heart rate and muscle tension. This form of therapy involves instrumentation that tracks specific physiologic indication of tension in the body. The most common form of biofeedback involves using electromyographic feedback from the affected region. It is helpful in low back pain and headache related to myofascial spasm."]

[text name="variable_1755" default=""]

Pharmacological Options:

[select name="variable_660" value="He|She|I"] [select name="variable_662" value="has tried|is taking|has not tried|Offered"] [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"] [select name="variable_663" value="|in the past for chronic pain management|at the moment"]. [text name="variable_693" default=""]
[checkbox name="variable_664" value="common side effect profiles, their onset of action and dosing discussed with patient.|The general side effects, possible interactions, and potential adverse effects of this medication discussed with the patient. The patient appeared to understand and wishes to proceed with this pharmacological therapy.|I did not change, discontinue or add any medication today but this option might be considered in future."] [text name="variable_665" default=""]

Interventional Options:

[select name="variable_614" value="I recommended a trial of nerve block for|I did not offer trial of nerve block for"] [checkbox name="variable_615" value="Low back pain|Upper Back Pain|Back Pain|Neck pain|Neck and shoulder pain|shoulder pain|Neuropathic pain"],[text name="variable_616" default=""]
The palliative nature of these blocks was explained to the patient. [checkbox name="variable_617" value="The patient appeared to understand and wishes to proceed with this therapy|The patient was reluctant to consider this option; we will remain available to trial this option should they have a change of opinion|I performed several blocks over Lumbar area|I performed several blocks over Neck and shoulder area|I performed some block over neck and head area for headache|patient had relief of pain after nerve blocks|I will follow patient in a week for re-asessment|I will follow patient in two weeks for re-asessment|I will follow patient in three weeks for re-asessment|I will follow patient in a month for re-asessment|Patient is on anti-coagulant and not a suitable candidate for injections, discussed with patient"].
[text name="variable_695" default=""].
Follow up in [select name="variable_54" value="a week|two weeks|three weeks|a month"]
Patient advised to get a Nerve block information package from front desk.
Subjective:
Thank you for referring this , to Pain Care Clinics at on with complaint of . main complaint is . .
Pain started as patient explains due to . describes a pain with character of
with severity of /10 at the worse and /10 at the moment.
Pain radiates to
Pain gets worse with and gets better with
Past Pain Medications:
.
Current Pain Medications:
.
Past Physical Therapy:

Past Medical History:

Allergies : Patient and
Family History:

Sleep:


Sexual life :


Psychiatric History:


Opioid Risk Tool

1. Gender



Social:
Patient is currently ,Lives and has children .

Smoking:
ETOH:
Recreational Drugs:

On Examination:
Afebrile, vitals in chart.
Not in acute distress, good eye contact, cooperative
PERRLA, no jaundice no pallor, no bruises, no ecchymosis, no cyanosis
Normal capillary refill.
On physical exam today, I found the patient to be , oriented to person, place and time. .
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.
My objective findings as related to the injuries are as follows:










IMPRESSION
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2-
3-
4-
5-


Treatment Plan:
Patient treatment is considered in three domains: interventional, pharmacological, and patient-centric recommendations. With this in mind the following recommendations are suggested:
Patient-centric Recommendations:








Pharmacological Options:

.


Interventional Options:

,
The palliative nature of these blocks was explained to the patient. .
.
Follow up in
Patient advised to get a Nerve block information package from front desk.

Result - Copy and paste this output: