MDforever
Back to Orthopedics

Spine Disorders Symptom & Progress Tracking Sheet

Daily Monitoring Tool for Spine-Related Conditions

Orthopedics

Create Your Video Presentation

This template doesn't have any video presentations yet. Be the first to create one!

Create Your Own AI Avatar Video

Record yourself for just 2 minutes to generate a professional AI video for your patients.

Get Started

Create Your AI Avatar

Be the first to create a video version of this content featuring your own AI avatar - just submit a quick 2-minute recording.

Create My AI Avatar Login

Template Content

Last updated: Mar 24, 2025

Patient Information

Name: ___________________ Date: //___ Diagnosis: ________________ Provider: ________________

Pain Assessment

Pain Level (0-10)

Morning: ___ Afternoon: ___ Evening: ___

Pain Location (mark all that apply)

  • Neck
  • Upper back
  • Middle back
  • Lower back
  • Radiating to arms
  • Radiating to legs

Daily Activities Impact

Mobility (check one)

  • Full mobility
  • Slightly limited
  • Moderately limited
  • Severely limited

Activities Affected Today

  • Walking
  • Sitting
  • Standing
  • Sleeping
  • Work duties
  • Household tasks

Treatment Adherence

Medications Taken

Medication: _____________ Time: _____ Dose: _____ Medication: _____________ Time: _____ Dose: _____

Exercises Completed

  • Prescribed stretches
  • Core strengthening
  • Walking program
  • Physical therapy exercises

Additional Notes

Triggers/Factors that worsened symptoms:

Activities that provided relief:

Follow-up

Next appointment: //___ Provider notes: _________________________

Create Your AI Avatar

Be the first to create a video version of this content featuring your own AI avatar - just submit a quick 2-minute recording.

Create My AI Avatar Login & Customize

Features

  • Create a professional AI avatar with just a 2-minute recording
  • AI-powered personalization
  • Editable content
  • Ready to share with patients