Advanced Chiropractic, P

REPORT OF FINDINGS










































TREATMENT PLAN

PHASE I [ACUTE] PHASE II [SUBACUTE]

Start ___ / ___ / ___ Start ___ / ___ / ___
Duration _________ (2-4 weeks) Duration _________
(4 weeks)
Frequency _________ (2-3 times per week) Frequency _________
(1-2 times per week)
Goals Goals
Reduce pain/symptoms ______% (50-75%) Reduce pain/symptoms
______% (75-100%)
Decrease muscular spasm Improve ROM ______% (75-
100%)
Improve ROM ______% (25-50%) Transition passive to active
care rehabilitation
Treatment Treatment
( Spinal Adjustment ( Spinal Adjustment

( Extremity Adjustment ( Extremity Adjustment

( Joint Mobilization ( Joint Mobilization
( Intersegmental Traction ( Intersegmental Traction
( Myofascial Release ( Myofascial Release
( Trigger Point Therapy ( Mirror-Image
Adjustment
( AROM / Stretching ( Manual Traction
( Other _______________ ( Proprioception Exercises
( Other _______________ ( Isometric Exercises
( Other _______________ ( Other ______________
( Other _______________ ( Other ______________
Current Dx: ________________________ Current Dx:
______________________
___________________________________
_________________________________
Notes: _____________________________ Notes:
___________________________
___________________________________
_________________________________


PHASE III [REHABILITATIVE] PHASE IV [MAINTENANCE]

Start ___ / ___ / ___ Start ___ / ___ / ___
Duration _________ (4-8 weeks) Duration _________
(4 weeks +)
Frequency _________ (1 times per week) Frequency _________
(1-4 times per month / PRN)
Goals Goals
Strengthen & Support Postural/Functional Weaknesses Maintain Improved
Function
Improve Functional Stability Maintain Pain-free Status
Posture & Saggital Curve Correction Sustain Corrections
Achieved During Phase III Care
ADL / Function Improvement ___________________ Prevent Deterioration of
Function
Treatment Treatment
( Spinal Adjustment ( Spinal Adjustment

( Extremity Adjustment ( Extremity Adjustment

( Joint Mobilization ( Joint Mobilization
( Intersegmental Traction ( Mirror-Image Adjustment
( Mechanical Traction ( Intersegmental
Traction ( Myofascial Release
( Manual Traction
( Isotonic Strengthening ( Other _____________
( Therapeutic Activities ( Other _____________
( Cardio/Elliptical (Warm-up)
( Other _______________
Current Dx:
____________________________________________________________________________
_____
Notes:
____________________________________________________________________________

____________________________________________________________________________
_____
-----------------------


Reason for seeking chiropractic care:

1.
__________________________________________________________________________
_____
2.
__________________________________________________________________________
_____
3.
__________________________________________________________________________
_____
4.
__________________________________________________________________________
_____

Functional deficits & impaired activities of daily living:

1.
__________________________________________________________________________
_____
2.
__________________________________________________________________________
_____
3.
__________________________________________________________________________
_____
4.
__________________________________________________________________________
_____
5.
____________________________________________________________________________
___

Prior macro & micro traumas correlated to current problem(s):

1.
__________________________________________________________________________
_____
2.
__________________________________________________________________________
_____
3.
__________________________________________________________________________
_____
4.
__________________________________________________________________________
_____
5.
__________________________________________________________________________
_____

Significant examination findings:

_____ Restricted Ranges of Motion _____ Muscular Weakness
_____ Abnormal DTR
_____ Abnormal Posture _____ Trigger Points _____
Positive Orthopedic Tests
_____ Joint Complex Dysfunction _____ Myofascial Instability _____
Numbness
_____ Weight Distribution >5 lbs. _____ Asymmetric Contract _____
Tingling / Paresthesia
_____ Abnormal Gait _____ Palpatory Tenderness _____
Paralysis
_____ Asymmetric Dynanometry _____ Referred Pain
_____ Abnormal Dermatomes

Significant X-ray findings:

1.
__________________________________________________________________________
______
2.
__________________________________________________________________________
______
3.
__________________________________________________________________________
______
4.
__________________________________________________________________________
______
5.
__________________________________________________________________________
______