1. This is the Symptoms Form
The front desk assistant has the patient fill this out at the first exam and each and every re-exam until the patient is released from care.
Give it to the Doctor so that he/she may use it during the consultation with the patient.
The Doctor may ask for more details about the patient’s symptoms and fill in more boxes if needed.
(Use Arrow Keys to move forward or backward in presentation)

2. The Symptoms Form should be filled out like this
Blacken in all the boxes
Do not make check marks
Do not make X’s
(On re-exam days, explain to patient to check any symptoms they have experienced since the last re-exam day, even if he/she is not experiencing them at that moment in the office.)
This is easy to read from a 4th or 5th generation photocopy, which is what the claims adjuster looks at when deciding how much to give the patient in the PI settlement.

3. “Clunk”
Sound in Neck
When the patient either feels or hears a “clunk” feeling or sound in his/her neck after trauma, the most likely diagnosis is
Ligament Instability
The Doctor must carefully examine the flexion and extension neck x-ray films for evidence of translation.

4. Pain
Patients understand pain, so they should have no trouble filling out the section next 21 lines asking about pains throughout their body.

5. Contusions
A bruise, or contusion, is caused when blood vessels are damaged or broken as the result of a blow to the skin (be it bumping against something or hitting yourself with a hammer). The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body's response to the injury. A purplish, flat bruise that occurs when blood leaks out into the top layers of skin is referred to as an ecchymosis.
Contusions also occur when body parts hit against each other, damaging the tissues and causing blood to leak into the tissues.
Most “sprains” have a contusion element to it, causing the tissues to swell.
The Doctor may need to fill in the Contusion box and not all the areas of sprain where tissue bleeding/swelling has occurred.

6. Neurological Symptoms
The patient should know whether their hand or foot is numb, but many do not understand this. Explain that:
Numb = Absence of Sensation
Tingle = Pins & Needles
Weak = Clumsy, can’t function
The Doctor must find the source of the neurological symptoms, using exam tests, MRI, NCV, Digital Motion Xray,
and referral to MD/neurologist.

7. Symptoms Associated with Injuries
It may seem that ALL the symptoms are associated with the injuries, but Colossus gives special weight to these particular symptoms, so they are in a separate, easy-to-find place so the claims adjuster can’t miss them.
When the Doctor prepares the Narrative Report, many of these symptoms will be tied to every injured diagnosis.
For example, Range of motion problems occur because of
(1) bone injury
(2) tendon injury
(3) ligament injury
(4) Muscle injury
(5) Nerve injury
In each and every joint !!!

8. Headaches Headaches occur because of (1) bone injury (2) tendon injury
(3) ligament injury
(4) Muscle injury
(5) Nerve injury
In every part of the spine !!!

9. Muscle Spasms Muscle spasms occur In EVERY part of the spine
And extremities
Use in every injured body part to document the spasms

10. Dizziness Dizziness occurs because of (1) bone injury
(2) tendon injury
(3) ligament injury
(4) Muscle injury
(5) Nerve injury
In every part of the spine …
As well as brain injury
Can’t the patient feel woozy/dizzy because of the intense pain in his/her foot? Knee? Hip? Hand?

11. Visual Disturbances occur
when there is a concussion. The patient won’t remember the time they were unconscious… Duuuh !
If they occurred even for a few moments after the accident, document them. They are also more common than most Doctors realize, even months after the accident. Often that patient has been to the optometrist to get their glasses “fixed”, not realizing their visual disturbance is from the accident and the concussion.

12. Sleep Disruption
Sleep Disruption means ANY thing interfering with normal sleep patterns.
Concussion = Sleeping too much
Pain = Not Sleeping enough
Every injury causes some type of sleep disruption… so the patient is tired during the day and must take naps… or doze off
Finger pain keeps patient awake
Neck pain keeps patient awake
Back pain keeps patient awake
Contusions keep patient awake
Sprains keep patient awake
Ligament laxity keeps patient awake
TMJ pain keeps patient awake
The Doctor should attribute the Sleep disruption to EVERY diagnosis. Just make sure the patient understands to check this box, and why.

13. Radiating Pain
Most, if not all, injured body parts radiate pain somewhere.
Finger pain radiates to wrist
Neck pain radiates to head
Back pain radiates to hip/leg
Contusions radiate to surrounding tissues
Sprains radiate outward
Ligament laxity in neck radiates to shoulders
TMJ radiates to head (headache)
The Doctor should attribute the Radiating Pain to EVERY diagnosis. Just make sure the patient understands to check this box, and why.

14. Anxiety Anxiety occurs because of (1) bone injury (2) tendon injury
(3) ligament injury
(4) Muscle injury
(5) Nerve injury
In every joint of the body !!!
Patients are anxious/nervous or scared they will never get well, that they won’t be able to work because of the pain, etc.

15. Anxiety Post-Traumatic Stress Disorder Brain Concussion
Anxiety also occurs because of
Post-Traumatic Stress Disorder
Brain Concussion
Worrying about getting fired
Can’t think clearly
Driving near accident scene
The Doctor should associate Anxiety with every Diagnosis in the Report

16. Depression Pain Post-Traumatic Stress Disorder Brain Concussion
Depression occurs because of
Pain
Post-Traumatic Stress Disorder
Brain Concussion
Worrying about getting fired
Can’t think clearly
Driving near accident scene
The Doctor should associate Depression with every Diagnosis in the Report

17. that the patient is taking them.
OTC Medications
Although the chiropractor cannot prescribe OTC medications in most states, the chiropractic office must
DOCUMENT
that the patient is taking them.
Taking OTC medications longer than 30 days is “prolonged” medication in Colossus and carries a 3X multiplier value.
If the patient is taking them more than three days a week, it is “intensive”, which is also a 3X multiplier. The doctor should note how many days a week the patient is taking the meds during the consultation.
3X3 = 9 times the value if the DC merely documents the patient took OTC meds three times a week for more than 30 days.

18. The entire right side of the Symptoms form has Concussion Symptoms.
Brain/MTBI
The entire right side of the Symptoms form has Concussion Symptoms.
When 3 or more of these symptoms exist, the patient has a brain concussion, aka Mild Traumatic Brain Injury (MTBI)
The Doctor must diagnose the brain injuries and either treat it or refer it out to a neurologist for further evaluation and treatment.

19. This is the Symptoms Form
In Summary…
This is the Symptoms Form
The front desk assistant has the patient fill this out at the first exam and each and every re-exam until the patient is released from care.
Give it to the Doctor so that he/she may use it during the consultation with the patient.
The Doctor may ask for more details about the patient’s symptoms and fill in more boxes if needed.

20. The End