Low Back Pain/Injury
Onset prior to evaluation
Onset while:
Injury at:

Associated Pain (0=none, 10=severe)
Location:
Radiation:
Severity now (0-10):
Severity at worst (0-10):
Duration:
Characterized as .

Relieved with
Worse with
<-- worse with cough

Pitfall evaluation:
<-- fever
<-- hematuria
<-- inner thigh numbness
<-- foot drop
<-- urine retention or incontinence
<-- stool retention or incontinence

<-- prior back pain history with last episode
<-- intervertebral disc injury
<-- spine surgery history

<-- compression fracture or osteoporosis history
<-- nephrolithiasis history
<-- peptic ulcer disease history
<-- aortic aneurysm history or risk (age over 60, tobacco history)
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Result - Copy and paste this output: