Case Study

Case Study (Unstructured)
Form Completion; Instructions Video Printing Instructions Process Information; Observations Rationale Theoretical Thinking Hypothesis Protocol Summary Protocol
1.) First Name		2.) Last Name
3.) E-Mail		4.) Web Page
5.) Phone		6.) Profession	Massage Therapist Chiropractor Medical Doctor Osteopath Physical Therapist Other (Specify)
7.) Other Profession
8.) Dates of Service From-To (Mo,Yr Range)		9.) Clients Initials (1st & Last) or #	10.) M.D. Diagnosis & ICDM-9 code.
11.) Cost Savings	Surgery Prevented Yes No	Cost Savings? Yes No	Est. Cost Savings surgery?
Disability Payments Saved? Yes No	Est. Cost Savings Disability?	Savings between MT vs. PT/Chiro visits?	Sick Leave Savings est?
12.) M.D. & M.T. Assessment Concur? Yes No	13.) Chiropractor & M.T. Assessment Concur? Yes No	14.) P.T. & M.T. Assessment Concur? Yes No	15.) Professional Concurrence, Disagreements, 2nd Opinions Explained.
16.) Case Description & #
	17.) Additional Comments.