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Sis and Therapy History: Page One Patient responses are recorded but supplemented by the clinician as appropriate Referral: GP General Practitioner Ortho Orthopaedic Specialist Postures / Stresses: Functional Disability from Present Episode: Functional Disability Score: VAS Score: VAS visual analog scale Body Chart: Present Symptoms: Present Since: Improving / Unchanging / Worsening: Commenced as a Result of: Symptoms at Onset: Constant / Intermittent: Better / Worse Section: am.

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