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|
---
patient: "Jane Doe"
type: "assessment"
date: 2020-01-08
toc: true
---
# Jane Doe
**Date of assessment:** 8 January 2020
## Patient Details
#### Date of birth: *(age at time of assessment)*
#### Email address:
#### Other contact details: *(if provided)*
#### Occupation:
#### General medical history: *(previous injuries, medications, operations, etc)*
#### Red flags:
#### Daily activity level:
#### Sport / exercise: *(type, level, position, competition, training, intensity, frequency, duration)*
## Subjective Assessment
#### Description of main problem:
#### Location:
#### History of main problem: *(and previous treatment if applicable)*
#### Pain level and description:
#### Aggravating:
#### Easing:
#### 24 hour cycle: *(On wake, on rise, day, evening, sleeping)*
#### SIN:
#### Do they have any theories on what the problem is?
#### What questions / worries / major concerns do they have?
## Objective Assessment
#### Observation:
#### Palpation:
### Physiological Movements
| Area | Action | Active | Passive | Resisted |
| ---- | ------ | ------ | ------- | -------- |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
### Accessory Movements
| Area | Accessory | Pain / Stiffness / NAD / ROM |
| ---- | --------- | ---------------------------- |
| | | |
| | | |
| | | |
| | | |
### Muscle Tests
| Muscle | Notes |
| ------ | ----- |
| | |
| | |
| | |
| | |
### Ligament Tests
| Ligament | Notes |
| -------- | ----- |
| | |
| | |
| | |
| | |
### Special Tests
| Test | +ive / -ive | Notes |
| ---- | ----------- | ----- |
| | | |
| | | |
| | | |
| | | |
### Joints Above/Below
| Area | Action | Notes |
| ---- | ------ | ----- |
| | | |
| | | |
| | | |
| | | |
### Other Notes & Diagnosis
#### Additional comments:
#### Working diagnosis:
## Treatment
#### What are they looking for from treatment?
#### What do they think will help?
#### What barriers to success can we identify?
#### General advice / education given: *(Timeframes, physiology, expectations, resources)*
#### Goals, timeframes and markers:
#### Details of exercises given: *(What, when, why, how long/much, daily movement, graded, flare ups, equipment)*
|
