The following form should be available in CCC. If not, ask the front desk staff or check with your preceptor. The exam should be performed on a patient with a complaint of low back pain. If you have not been scheduled a patient with low back pain, we will accept the use of a volunteer stand-in. The chart should be complete and contain the elements of history noted below. If you are using a volunteer instead of a patient, demonstrate your understanding of how an HPI for this complaint would be written by documenting one on the back of the page.

If you are uncertain of any terms listed below or how to perform any of the tests, please check with your preceptor. You may also find the chapter on Low Back Pain helpful.

Please note - The availability of preceptors to grade you on this may differ depending on how the clinic is doing. Do not wait until the last minute. The preceptors cannot do these checklists for a large number of students in the week or two before the deadline and still have the clinic run smoothly.

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updated 6/13/05 - dlp