d d d d d d
ChiefdComplaint
HowdcandIdhelpdyoudtoday?
Dodyoudhavedanydotherdsymptomsdordconcernsdwedshouldddiscuss?d
Havedyoudhaddanydtraumadtodyourdback?
OlddcartsdfordHPI
Whatdaredthedeventsdsurroundingdthedstartdofdyourdbackdpain?
Whatdaredthedeventsdsurroundingdthedstartdofdthedpaindindyourdleg(s)?d
Whenddiddthedpaindindyourdbackdstart?
Doesdthedpaindindyourdbackdradiatedsomeplacedelse?dWhere?d
Wheredmoredpreciselydisdthedpaindindyourdleg(s)?
Wheredmoredpreciselydisdthedpaindindyourdback?d
Doesdthedpaindindyourdbackdcomedanddgo?
Whatddoesdthedpaindindyourdbackdfeeldlike?d
Dodyoudhavedpaindwhendlifting?
Doesdanythingdmakedthedpaindindyourdbackdbetterdordworse?d
Howdsevered(1-10dScale)disdthedpaindindyourdback?
PMH,dFH,dSHdasdNeeded
Anydnewdordrecentdchangedindmedications?
Aredyoudtakingdanydoverdthedcounterdordherbaldmedications?d
Dodyoudhavedanydallergies?
ReviewdofdSystemsd(ROS)
Dodyoudhavedproblemsdwithdheatdordcolddintolerance,dincreaseddthirst,dincreaseddsweating,df
requentdurination,dordchangedindappetite?
Dodyoudhavedproblemsdwithddizziness,dfainting,dspinningdroom,dseizures,dweakness,dnumbness,dt
ingling,dordtremor?
Dodyoudhavedproblemsdwithdfatigue,ddifficultydsleeping,dunintentionaldweightdlossdordgain,dfevers,