Neck/Upper 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 or deep breathing

Pitfall evaluation:
<-- fever
<-- chest pain
<-- shortness of breath
<-- extremity weakness
<-- prior neck or back pain history with last episode
<-- intervertebral disc injury
<-- spine surgery history
<-- compression fracture or osteoporosis history
<-- heart disease history
<-- aortic dissection history or risk (hypertension)
<-- peptic ulcer disease history

Result - Copy and paste this output: