NECK Appearance* Normal Swelling Redness Erythema Deformity Scars OtherPalpation* 1. Nuchal Line 2. Cervical Lamina Right 3. Cervical Lamina Left 4. Cervical Facets Right 5. Cervical Facets Left 6. Transverse Process Right 7. Transverse Process Left 8. Other Observed Abnormality? Yes No Sensation Intact? Yes No Moves Extremities w/o Deficit? Yes No Strength 1 2 3 4 5 Deep Tendon Reflexes 0 1 2 3 4 Procedure Note Consent Skin Cleaned with Chlohexadine Other Tender Points Injected with: Dextrose PRP Joint Injection: Dextrose PRP Stem Cell Resolution of Symptoms? Yes No Tolerated Well? Yes No Procedural Sedation:Medication 1AtivanDilaudidDemerolFentanylKetamineMorphineValiumVerscelDose Medication 2AtivanDilaudidDemerolFentanylKetamineMorphineValiumVerscelDose Medication 3AtivanDilaudidDemerolFentanylKetamineMorphineValiumVerscelDose Δ
