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Physio Review
Patient Assessment - Page 1 (Edit)
Date *
Patient Name *
PR No
Age / Gender *
F
M
T
Contact No
Reference
Address
Kalavasal
Occupation Type *
Select
Government
Non-Government
Senior Citizen
Others
Designation
Nature of Work
Select
Active
Desktop
Field
Travel
House Holder
others
Vitals
HEIGHT
WEIGHT
BP
PR
TEMP
SPO2
Other Health Issues & Treatment History
-
+ Add Row
History of Present Complaints
2+ months, right heel pain - Insidious onset 1+ month Right heel pain - Insidious onset / Right knee pain SUDDEN WEIGHT GAIN OF 6KG IN 3 MONTHS - Medicines for Ear and dental pain - Informed the patient to check with a neuro for any neuro problems - Trigeminal neurolgia
Onset
Sudden
Insidious
Gradual
Treatment Taken
Dr Anand, D ortho x medication x 1 month x not recovered
Investigation Details
Not Taken
Done , Not Produced
Attached with Case Sheet
Current Physiotherapy Episode
1
2
>3
Previous Session Details
NA
Update
Present Complaints
Pain - BL heel pain - Right > Left Wakeup pain - pain after a brief sitting and walk Knee pain - Left side - Inferior and anterior portion of the knee Knee pain - Pain in getting up from the chair - stairs
Symptoms
Constant
Intermittent
Worsening Factors
Relieving Factors
Pain Chart Notes
44 - 45
Pain Scale
Worst
Same
Better
VAS
At Worst
At Best
Pain Type
Nociceptive
Neuropathic
Nociplastic
Skin Colour
Scar
Adherent
Non-Adherent
No Scar
Swelling
Soft Fluctuating
Leathery
Tough
Dry
Tened
Hard
Boggy
Spongy
Thick
8 to 24 Hours of Injury
Tenderness
Grade I
Grade II
Grade III
Grade IV
Remarks
Right heel Gr.III Left heel Gr.II
Update
Edit - Page 3
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Patient Management
Edit - Page 3
ROM
AROM
Movement
Side
Part
Plane
Available Range
Pain Starts
Action
Select
Left
Right
Select
Neck
Wrist
Shoulder
Elbow
Spine
Hip
Knee
Ankle
Select
Sagittal
Frontal
Transverse
-
+ Add AROM
PROM
Movement
Side
Part
Plane
Available Range
Pain Starts
Action
Select
Left
Right
Select
Neck
Wrist
Shoulder
Elbow
Spine
Hip
Knee
Ankle
Select
Sagittal
Frontal
Transverse
-
+ Add PROM
End Feel
Soft
Firm
Hard
Empty
MMT
-
+ Add MMT
Special Tests
Special Test 1
Special Test 2
Remarks
FOCUS: Pain modulation - Tendon loading(Start with MVIC 70 to 80%) - progress from 3rd week isotonic heavy loading 80% - Check for pain scale should not above 4/10
Diagnosis
Patient Goals & Concerns
Physiotherapy Goals
Short Term Goals
Long Term Goals
Action
-
+ Add Goal
Further Referral (if needed)
Physiotherapist Details
Assessed Physio Name
IAP Membership No.
Treatment In-Charge Name
IAP Membership No.
Update
Electrotherapy
Modality
Site
Details
Date
Remarks
Action
-
-
+ Add Row
Supportive Techniques
Technique
Details
Date
Remarks
Action
5 sessions on alternate days
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Corrective Exercises
S.No
Exercise
Sets
Reps
Time
Date
Remarks
Action
1
-
2
-
3
-
4
-
5
Modified
-
6
-
7
-
8
-
9
Modified
-
10
-
11
-
12
-
+ Add Row
Date
Remarks
3 sessions per week
Update
