LBP Outcomes Data Entry Portal
Clinic Name (optional)
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Practice Setting
Clinic Location
Payer Source
Referral Source
Diagnosis
Previous Medical Intervention
Required
Co-morbidities (select all that apply)
Duration of Symptoms
Number of Visits
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Discharge Disposition
Oswestry Score - Initial (%)
Your answer
Oswestry Score - Discharge (%)
Your answer
Patient Specific Functional Scale - Initial
Your answer
Patient Specific Functional Scale - Discharge
Your answer
Pain Rating - Initial
Pain Rating - Discharge
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