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Assessment Performa: Demographic Data

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Rashi Jain
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20 views2 pages

Assessment Performa: Demographic Data

Uploaded by

Rashi Jain
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Assessment Performa

Demographic data:
Name:
Age:
Gender:
Occupation:
Address:
Chief complaint:

History:
Present history:

Past history:
Medical history:
Surgical history:
Family history:
Personal history:
Pain history:
Onset:
Site:
Side:
Aggravating factor:
Relieving factor:
Type:
NPRS:

On examination
Range of motion:

Manual muscle testing:

Investigations -

Special test-  

Provisional diagnosis- 

Treatment-
Short term goal:

Long term goal:

Electrotherapy Modalities:

Exercise programme: 

Home Advice:

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