Chiropractic Record Attachment (CHIRO)

 

 

Data Field Information
Prompt Response Req Len
Date of Initial Treatment Enter the date you want or click the calendar icon to select a date.

10
Date of Last X-Ray Enter the date you want or click the calendar icon to select a date.   10
# in Series Enter the number in the series.   50
Level of Subluxation Enter the level of subluxation.   50
Treatment Months/Yrs Enter the number of treatment months/years.   50
Number of Treatment/Mos Enter the number of the treatment/months.   50
Nature of Condition Select the condition you want from the list.

1
Date of Acute Manifestation Enter the date you want or click the calendar icon to select a date.  

10
Complication Indicator Select the indicator you want from the list.  

1
Symptoms Enter the patient's symptoms.  

50
X-Rays on File If there are x-rays on file for the patient, select this check box.  

1
Patient Condition Line 1 and Line 2 Enter the patient condition.  

50