Intake Form Review Flashcards
1
Q
Si Pa
A
Sight of Pain
2
Q
Segments
A
Ca
Cu
3
Q
Location
A
An
Re
4
Q
Side
A
Right
Left
5
Q
Duration
(Acu ? )
A
Pain levels
Lowest to highest
Ex 2-9
6
Q
T
Truma
A
Yes or no
7
Q
Rec/Con
A
Recurring?
Consistency?
Per week/day
8
Q
Extremities
A
CP. Head
DI. Hand
PE. Feet
9
Q
Pa Prev
A
Pain Previous
(Old is Gold)
10
Q
Surgery
A
Surgery’s in past
If many. Hardest to recover from
11
Q
Trauma/Fracture
A
Accidents/ Breaks/ Bad Falls/
Sprains/
*if many- hardest to recover from or not recovered
12
Q
Mo Ve
A
Movement Verifications
*segment of Si Pa (sight of pain that you are treating today in next few sessions
13
Q
PA VE
A
Palpation Verifications
14
Q
Sagittal
A
Ante / Retro
Lt left
Rt right
15
Q
Frontal
A
Medio
Latero
16
Q
Horizontal
A
IntraLatero
ExtraLatero
17
Q
HYP A / D
A
Hypothesis
A- Ascending
Or
D- Descending
*Don’t forget to do MoVe
Standing and sitting!
