Front Appearance NormalSwellingRednessErythemaDeformityScars Palpation 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 Strength12345 Deep Tendon Reflexes01234 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 1: Ativan Dilaudid Demerol Fentanyl Ketamine Morphine Valium Verscel Dose Medication 2: Ativan Dilaudid Demerol Fentanyl Ketamine Morphine Valium Verscel Dose Medication 3: Ativan Dilaudid Demerol Fentanyl Ketamine Morphine Valium Verscel Dose Δ
