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Chirocode form cwd1700

Chirocode form cwd1700 2025

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The document outlines the instructions for completing the Initial Evaluation & Management form (CWD1700) used by healthcare practitioners, specifically in chiropractic settings. It details sections for patient input regarding pain, health history, and symptoms, as well as sections for practitioners to assess range of motion, asymmetry, tissue palpation, and conduct a thorough examination. The form facilitates the collection of essential information to develop a treatment plan and diagnosis.

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Click ‘Get Form’ to open it in the editor.
Begin with the Patient Portion. Fill in your date, name, and age at the top of the form. Provide a brief description of your visit reason.
Indicate areas of pain by placing 'X's on the provided diagram and qualify the pain using letters (A for Ache, B for Burning, etc.).
Complete your health history by detailing prior illnesses, hospitalizations, surgeries, and medications. Don’t forget to sign at the bottom.
For the Office Portion, a trained CA will fill out range of motion assessments based on your responses. Ensure they mark any misalignments using arrows.
The practitioner will review your health history and ask follow-up questions before completing the examination findings and treatment plan.

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