Intake Screen

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Injury History

General Observation

C Spine

C Spine Flexion

C Spine Flexion Quadrant

C Spine Extension

C Spine Extension Quadrant

C Spine Foraminal Compression

C Spine Pain

RPE 1-10

C Spine Pain Area

C Spine Comments

T Spine

T Spine Flexion

T Spine Extension

Ext/Flex Position

T Spine Rotation Left

T Spine Rotation Right

T Spine Comments

L Spine

L Spine Flexion

Flexion Quadrant

L Spine Extension

Extension Quadrant

L Spine Rotation Left

L Spine Rotation Right

L Spine Side Flexion Left

L Spine Side Flexion Right

L Spine Comments

Pelvic Allignment

Positional Interpretation

Leg Length Discrepancy

Hip ROM

Thomas Test Left

Thomas Test Right

Hip Flexion Left

Hip Flexion Right

FABER Left

FABER Right

FADIR Left

FADIR Right

Hip Internal Rotation Left

Hip Internal Rotation Right

Hip External Rotation Left

Hip External Rotation Right

Hip Pain

RPE 1-10

Hip Pain Area

Other ROM

Hamstring Left

Hamstring Right

Ankle Left

Ankle Right

1st MTP Extn Left

1st MTP Extn Right