Patient's Name_____________________________________________ File No.__________
| KEY TO SOAP NOTES | Date | Date | Date |
| Cervical/Thoracic/Lumbar; Improved/Same/Worse/Resolved Slight/Mild/Moderate/Severe Pain - Occiput through Sacrum Muscle Spasm - Occ. to Sacrum Subluxation - Occ. to Sacrum Range of Motion - Adjust Areas Pelvic Deficiency,leg length PTmodalities: |
C-I.S.W.R; T-I.S.W.R; L-I.S.W.R Sl Mi M S/Sl Mi M S/Sl Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D Rt/Lt.. PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
| Date | Date | Date | Date |
| C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
| Date | Date | Date | Date |
| C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt .PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
| Date | Date | Date | Date |
| C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
| Date | Date | Date | Date |
| C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
| Date | Date | Date | Date |
| C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt./Lt. PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt./Llt. PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt./Llt. PT-H/I-E-U-M-D |
C-I.S.W.R T-I.S.W.R. L-I.S.W.R. Si Mi M S/Si Mi M S/Si Mi M S Po123456712345678910111212345S Mo123456712345678910111212345S So123456712345678910111212345S R.O.M. C-T-L Adj:O/C/T/L/S/Ex P.D. Rt/Lt. PT-H/I-E-U-M-D |
www.drbackman.com