New patient referrals to our clients: 781,392 Referrals as of 10/15/2018

Request for PFNCS testing

 

Patient Name:                                                                              Date:

 

Patients Symptoms/Chief complaint:

rNeck pain

rNeck pain with radiation to the shoulders R/L/both

rNeck pain with radiation to the upper extremities R/L/both

rLower back pain

rLower back pain with radiation to the hips/buttocks. R/L/both

rLower back pain with radiation to the lower extremities. R/L/both

 

Objective findings:

rDec ROM   rCervical rLumbar rBoth

rDecreased DTR 

rMuscular weakness 

rDermatomal hypoesthesia 

rPositive tests for neurologic compression at rCervical spine   rLumbar spine

rRadiating trigger points. 

 

Diagnosis: A-delta sensory fiber dysfunction with associated radicular proprioceptive dyskinesia and segmental biomechanical dysfunction.  Positive findings will be used to enhance the treatment plan of this patient by giving more accurate information as to the vertebral level and sides that are causing the patient’s pain and dysfunction.  The application of Chiropractic techniques will be recommended to these identified levels and sides with the purpose of improving the patient’s treatment outcome and safety.  When A-delta fiber dysfunction exists, this examination yields a higher degree of vertebral segmental biomechanical dysfunction analysis over palpation alone.

 

rA-delta sensory fiber Radiculopathy:  rCervical     rLumbar

 

Diagnostic dilemma:  (for purposes of designing or modifying this patient’s treatment plan)

 

rThis patient has been under care for a minimum of 4 weeks and continues to have spinal pain with radiation  of symptoms in one or more extremities.  We are looking to be more specific in our adjustment protocol in order to improve this patient’s outcome from our chiropractic adjustment program. I am requesting a PFNCS study of the Upper/Lowerextremities for A-delta fiber radiculopathy and if positive I request knowledge of the specific levels and sides to be adjusted going forward with this patient.  

 

rThis patient has been under care for a minimum of 8 weeks and continues to have spinal pain.  We are looking to be more specific in our adjustment protocol in order to improve this patient’s outcome from our chiropractic adjustment program.  I am requesting a PFNCS study of the Upper/Lower extremities for A-delta fiber radiculopathy and if positive I request knowledge of the specific levels and sides to be adjusted going forward with this patient.  

 

Signature: _______________                  Address:    

 

 

 

 

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