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KATZ CHIROPRACTIC & REHABILITATION CLINICPATIENT-ENCOUNTER FORM: _____________________________________ Date_________ EK SKCervicalAcquired DeformityM95.3CervicalgiaM54.2Cervical Disc Disorder w/myeC2-C4M50.01C4-C7M50.02C7-T1M50.03w/radiculopathyM50.11C2-C3C3 radic due to disc disorderC3-C4C4 radic due to disc disorderw/radiculopathyM50.12C4-C5C5 radic due to disc disorderC5-C6C6 radic due to disc disorderC6-C7C7 radic due to disc disorderw/radiculopathyM50.13C7-T1C8 radic due to disc disorderDisc DegenerationM50.3Dislocation (initial)Level(s) ____________Fracture (initial) closed, displacedInstabilityM53.2X2Fracture (initial), closed, displacedLevel(s) ____________InstabilityM53.2X2Kyphosis, Postural C-TM40.03Ligament Laxity/DisorderM24.28 RadiculopathyO-A-AM54.11CM54.12ScoliosisJuvenile. Idiopathic CM41.112Juvenile, idiopathic C-TM41.113Adolescent idiopathic CM41.122Adolescent idiopathic C-TM41.123Neuromuscular O-A-AM41.41Neuromuscular CM41.42Neuromuscular C-TM41.43Spinal StenosisO-A-AM48.01CM48.02C-TM48.03Spondylosis w/o mye or radO-A-AM47.811CM47.812C-TM47.813Spondylosis w/myeM47.12Sprain of LigamentsS13.4XX_Strain of muscle, fascia, tendonS16.1XX_ThoracicDeforming DorsopathiesM43.8X6_DegenerationT2-T12M51.34T12-L1M51.35Disc Herniation w/o myeT2-T12M51.24T12-L1M51.25Dislocation, unspecifiedS23.101AFacet Pain-Joint TenderM25.50Fracture, closedS22.009AWedge Level _______S22.08 __InstabilitiesM53.2X4Kyphosis, PosturalM40.04\Nerve Root DisorderG54.3Outlet SyndromeG54.0PainM54.6RadiculitisM54.14Rib PainR07.81Schmorl’s NodeM51.45Scoliosis, idiopathicM41.24Sprain of ligamentsSStenosisM48.04Spondylosis w/o myeT2-T12M47.814T12-L1T12-L1Spondylosis w/myeM47.14Sprain /StrainS23.3XXALumbarDeforming DorsopathiesM43.8X9Disc Degeneration (L2-L5)M51.36Disc Disorder w/o mye (L2-L5)M51.26Disc disorder w/radic. (L2-L4)M51.16Dislocation, unspecifiedS33.101AInstabilitiesM53.2X6Facet Pain/Joint, unspecifiedM25.50Lordosis, PosturalM40.46LumbalgiaM54.5w/R sciaticaM54.41w/L sciaticaM54.42RadiculopathyL2-L5M54.16L5-S1M54.17Sciatic NeuralgiaM54.30RightM54.31LeftM54.32SpasmM62.830Lumbar (con’t)Spondylosis w/o mye/radL2-L4M47.816L5-S1M47.817w/radiculopathyM47.26Spondylosis M43.06Spondylolisthesis (L2-L40)M43.16Sprain S33.5XXASprain (sequela)S33.9XXSStenosis L2-L5M48.06Strain, muscle, fascia,tendonS39.012AStiffnessM25.60FusionM43.26LumbrosacralDisc Degeneration (L5-S1)M51.37Disc Disorder w/radic. (L5-S1)M51.17Dislocation Sac JointS33.2XXAFusion(L5-S1)M43.27InstabilityM53.2X7Kyphosis, T-LM40.05Lordosis, PosturalM40.47Plexus DisorderG54.1Pain S33.8XXARadiculitisM54.17SacroillitisM46.1Spondylosis w/o mye/radM47.817Spondylolisthesis (L5-S1)M43.17 Stenosis L5-S1M48.07Dislocation Sac JointS33.2XXASacral/SacrococcygealFusionM43.28InstabilityM53.2X8Sprain, joint S43.409AStrain, muscle,fascia,tendonS46.919AJoint DerangementsM24.819Impingement SyndromeM75.40R shoulderM75.41L shoulderM76.42Impingement, LesionsM75.80SprainR acromioclavicularS43.911AL acromioclavicularS43.912AStrain, muscles-tendonsR rotator cuff AcuteS46.011AL rotator cuff AcuteS46.012Lower ExtremitiesAchilles tendinitis RM76._R ___ L ___Ankle PainM25.57_R ___ L ___Foot PainM79.67_R ___ L ___Hip PainM25.55_R ___ L ___Knee PainM25.56_R ___ L ___Leg PainM79.60_R ___ L ___Tibial syndromeM76.8___R ___ L ___Thigh PainM79.65_R ___ L ___Sprain, calcaneofibular ligS93.41__R ___ L ___Sprain of deltoid ligR ___ L ___Sprain of tibiofibular ligS93.43__R ___ L ___Osteoarthritis, localizedBilat KneeM17.0Unilat Knee RM17.11Unilat Knee LM17.12Upper ExtremetiesAdhesive capsulitisM75.0_R ___ L ___Bicipital tenosynovitisM75.2_Calcific TendinitisM75.30Carpal TunnelG54.0_R ___ L ___Impingement Syndrome, ShoulderM75.4_R___ L ___Segmental/SomaticDys Upper ExtM99.07SymptomsVertigoI69.998DizzinessR42HeadacheClusterG44-209Post-TraumaticG44-309Additional: __________________________________________________________________________________________ ................
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