The chiropractic physical examination form is the key document used to record a patient’s visit. It’s essential for creating a record of your patient’s condition and to help you determine the right treatment plan.
Along with a patient’s intake form, your physical examination form is a vital part of your SOAP notes — a list of your objective observations and your patient’s subjective description of their pain.
What Are Chiropractic Physical Examination Forms?
Physical examination forms can be customized to your practice and how you perform exams, however, they typically feature fields for the patient’s basic information and diagnostics like blood pressure and weight. There are also fields for observations like the patient’s appearance, nutrition, and other miscellaneous notes.
These examination forms need to be carefully organized and secured. It’s another form of protected health information (PHI) that falls under HIPAA rules and can result in hefty fines and other penalties if it’s not taken care of properly — physical or digital.
What Are the Different Kinds of Chiropractic Physical Examination Forms?
The type of physical examination forms you use is dependent on your area of expertise, and you can have different types of examination depending on the patient’s problem.
In the chiropractic field, there are typically different forms for cervical exams, lumbosacral exams, upper and lower extremity examinations, and other regions. It’s common practice that an initial form is started at first, especially if it’s for a new patient. Then additional pages for the different types of exams can be added as you identify the patient’s chief complaints.
Other pages can also include medical history and any advanced test results such as scoliosis screenings, radiology reports, or other results from lab work.
How Does eFileCabinet Make Your Chiropractic Physical Examination Forms More Dynamic?
With a robust document management system, you make the filing of examination forms easier, more accessible to you, and secure. Even if you fill out your notes on physical paper, it’s possible to file and organize them digitally with just a few simple steps and tools.
Zonal OCR is a dynamic feature that can record your physical forms, via scanner, and fill out a profile of data that you can easily access, using a template. It’s common for exam forms to feature lists of symptoms or locations of pain that you can indicate with a checkmark during the examination. Zonal has the capability to recognize checkmark boxes and record that date.
From there, you can create automation rules that file the forms into the right location in the system and perform other actions. For example, if you upload an examination form that checked some particularly bad symptoms, the system can be automated to recognize that and file it in a folder for urgent cases, automatically add notes for recommendations, or share it with a colleague for their expertise. It can even create brand new folders in the system, for instance when you’re working with a new patient.
Most importantly, when an exam form is uploaded to your eFileCabinet system, it’s uploaded to a secure and compliant cloud server, where nobody but you can have access to it — allowing you to confidently dispose of the physical copy, with no need to store it. This platform features an array of compliance tools to make your filing system as secure as you need. Permission settings make it so only authorized users can access data. You can adjust security settings such as password requirements and two-factor authentication. Each file and folder has retention governance you can set manually or automate. With these settings, you can protect files from being edited or deleted.
eFileCabinet has the versatility to make your chiropractic practice run more smoothly. Examination forms can be easily recalled during your patient’s next visit, with a new version easily appended to their file. It’s an efficient way of practicing SOAP note-taking and allows you to better focus on caring for your patient.