{literal} {/literal}

Head Pain and Temporomandibular Jaw Examination

REFERRED BY   
CHIEF COMPLAINTS


DATE OF ONSET  {html_select_date start_year="1910" time=$hptje_primary->get_date_of_onset() time=$hptje_primary->date_of_onset prefix="date_of_onset_"}


PRECIPITATING/AGGRAVATING EVENT:

Other Explain: 


get_prior_symptoms() eq 1}checked{/if}"> Denies presence of symptoms prior to accident    get_aggravated_symptoms() eq 1}checked{/if}> Affirms aggravation of symptoms after accident


{foreach name=loops item=headings key=title from=$checks} {if !is_numeric($row_title)} {else} {/if} {/foreach} {/foreach}
{if $smarty.foreach.loops.first ne 1}
{/if} {$title}
{foreach item=row key=row_title from=$headings}
{$row_title} {html_checkboxes name="checks" options=$row selected=$hptje_primary->checks separator=" "}
{html_checkboxes name="checks" options=$row selected=$hptje_primary->checks separator="   "} {if $title eq "Teeth"}   Sore#    Mobile#    Fractured#    Avulsed#  {elseif $title eq "Precipitating Factors" and $row_title eq 2}   {/if}
{section name="history" loop=8 start="0"} {/section}
HISTORY OF PREVIOUS TREATMENT
   A.Specialty
(A)Anesthesiologist (C) Chiropractor (D) Dentist (E) ENT (F) Family Physician (H) Hospital ER
(N) Neurologist (O)Orthopedist (P) Physical Therapist (R)Rheumatologist

   B.Treatment Modalities
(1)Chiropractic (2)Equilibration (3) Examination (4) Medication (5) MRI (6) Orthodontic (7) Orhtopedic
(8) Pallative (soft diet, heat, etc.) (9) Physical Therapy (10)Prolotherapy (11)Reconstruction (12) Referal
(13) Soft Collar (14) Cervical Immobilization (15) Splint Therapy (16) TMJ Surgery (17) X-rays

   C.Effectiveness of Treatment: (N) None  (F) Fair  (G)Good  (E)Excellent

DoctorSpecialtyTX RenderedEffectivenessDate
{section name="previous_accidents" loop=8 start="0"} {/section}


HISTORY OF PREVIOUS ACCIDENTS OR INJURIES
Nature of AccidentInjuriesDate
{if $VIEW != true} {/if}
COMMENTS
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