NFPA 1582-Physcial exam form

Pain Type No Pain Pain Numbness Tingling Muscle Spasms Burning Severity Mild Mild to Moderate Moderate Moderate to Severe Severe What makes it better? Medication Lying Down Standing Sitting Stretching Range of Motion Nothing ... Neck Right Ear Left Ear Right Eye Left Eye. Face Right Jaw Left Jaw. Right Upper back Left Upper back Right Shoulder ... ................
................