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    Appearance


    Palpation
    1. Top Right
    2. Top Left
    3. Mid Right
    4. Mid Left
    5. Low Right
    6. Low Left
    7. Other
    Observed Abnormality? Yes No

    Sensation Intact? Yes No

    Moves Extremities w/o Deficit? Yes No



    Range of Motion

    Flexion
    FullLimited    LevelPainExplain
    Extension
    FullLimited    LevelPainExplain
    Sidebending Right
    FullLimited    LevelPainExplain
    Sidebending Left
    FullLimited    LevelPainExplain
    Rotation
    FullLimited    LevelPainExplain


    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:
    Dose

    Dose

    Dose