Please also check the insurance billing manual updates and the blog for

 more information.

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Progress Report From:_________________________________

To:____________________________

Progress Report as of:___/___/___

 

Regarding:_____________________

 

Treatments since last report:_______

 

Current Rx expires:_______________

 

Overall Patient Progress is: ___Poor   ___Marginal  ___Good  ___Excellent

 

Areas Treated: ___Cervical  ___Thoracic   ___Lumbar  ___Sacral  ___Other ____

 

Subjective and Objective Observations

 

	Left	Right	No Current Problem	Improving	Not Improving	Increased Symptoms
Neck
Shoulder
Arm
Mid Back
Low Back
Pelvis
Leg

 

Patient rates their stress level as: ___Low  ___Moderate  ___High

 

Other Concerns/Comments:_____________________________________________

__________________________________________________________________

 Very Much for your referral.

Please also check the insurance billing manual updates and the blog for more information.

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