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N° Segments Locat Side Durat ( acu-1°) T/?

Si Pa
Pa Conc

Extremit.

Pa Prev

Surgery

Trauma

Fracture
HYPOTHESIS SAGITTAL PLANE FRONTAL PLANE
A D SEGME (lt) ANTE (rt) (lt) RETRO (rt) (an lt) MEDIO (rt)

Mo
Ve

Pa
Ve
date:
Treat
VRS (n-M) Rec/con Painful Movements:

Name:

Posture: Surname:

Medications: Date of Birth:

Internal dysf.: Occupation:

Investigations: Sport:

FRONTAL PLANE HORIZONTAL PLANE


(lt) LATERO (rt) (lt) INTRA (rt) (lt) EXTRA (rt)

Now
Outcome
2° trat.