LBP Outcomes Data Entry Portal
Clinic Name (optional)
Your answer
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 *
Your answer
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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