History - Lumbar facet-mediated pain

Structured fields

Section	Field	Key	Default layer	Required
Header	Clinician	`clinician_name`	Global Default	Required
Header	Encounter date	`encounter_date`	No Default	Required
Header	Condition focus	`condition_focus`	Per-Form Default	Required
History	Presenting complaint / reason for visit	`presenting_complaint`	No Default	Required
History	Pain location and distribution	`pain_location_distribution`	No Default	Required
History	Onset, duration, and course	`onset_duration_course`	No Default	Required
History	Mechanism/context and relevant history	`mechanism_context`	No Default	Optional
History	Pain quality, pattern, severity	`pain_quality_pattern`	No Default	Required
History	Aggravating and relieving factors	`aggravating_relieving`	No Default	Required
Function	Functional limitations and goals	`functional_limitations`	No Default	Required
Condition-specific	Condition-specific history prompts	`condition_specific_questions`	Per-Form Default	Optional
Treatment history	Prior conservative/interventional treatments and response	`prior_treatments`	No Default	Required
Treatment history	Current pain medications / relevant medication issues	`current_medications`	No Default	Required
Diagnostics	Imaging/labs/EMG and relevant reports reviewed	`imaging_labs_tests`	No Default	Optional
Safety	Red flags / neurologic / systemic screen	`red_flags_neuro_screen`	No Default	Required
Context	Sleep, mood, psychosocial and work/compensation context	`psychosocial_sleep_mood`	No Default	Optional
Plan	Patient preferences, affordability constraints, and treatment priorities	`patient_preferences_affordability`	No Default	Optional
Plan	History-based impression and plan	`history_impression_plan`	No Default	Required
Plan	History follow-up phrase	`history_followup_phrase`	Global Default	Optional

Section

Field

Key

Default layer

Required

Header

Clinician

clinician_name

Global Default

Required

Header

Encounter date

encounter_date

No Default

Required

Header

Condition focus

condition_focus

Per-Form Default

Required

History

Presenting complaint / reason for visit

presenting_complaint

No Default

Required

History

Pain location and distribution

pain_location_distribution

No Default

Required

History

Onset, duration, and course

onset_duration_course

No Default

Required

History

Mechanism/context and relevant history

mechanism_context

No Default

Optional

History

Pain quality, pattern, severity

pain_quality_pattern

No Default

Required

History

Aggravating and relieving factors

aggravating_relieving

No Default

Required

Function

Functional limitations and goals

functional_limitations

No Default

Required

Condition-specific

Condition-specific history prompts

condition_specific_questions

Per-Form Default

Optional

Treatment history

Prior conservative/interventional treatments and response

prior_treatments

No Default

Required

Treatment history

Current pain medications / relevant medication issues

current_medications

No Default

Required

Diagnostics

Imaging/labs/EMG and relevant reports reviewed

imaging_labs_tests

No Default

Optional

Safety

Red flags / neurologic / systemic screen

red_flags_neuro_screen

No Default

Required

Context

Sleep, mood, psychosocial and work/compensation context

psychosocial_sleep_mood

No Default

Optional

Plan

Patient preferences, affordability constraints, and treatment priorities

patient_preferences_affordability

No Default

Optional

Plan

History-based impression and plan

history_impression_plan

No Default

Required

Plan

History follow-up phrase

history_followup_phrase

Global Default

Optional

Narrative template

History template: Lumbar facet-mediated pain
Clinician: {{clinician_name}}. Date: {{encounter_date}}.

Presenting problem: {{presenting_complaint}}. Pain location/distribution: {{pain_location_distribution}}. Onset/course: {{onset_duration_course}}. Mechanism/context: {{mechanism_context}}. Pain quality/severity/pattern: {{pain_quality_pattern}}. Aggravating/relieving factors: {{aggravating_relieving}}.

Function/goals: {{functional_limitations}}. Condition-specific prompts/findings: {{condition_specific_questions}}.

Prior treatment response: {{prior_treatments}}. Current medications/relevant issues: {{current_medications}}. Diagnostics reviewed: {{imaging_labs_tests}}. Safety/red flags/neuro/systemic screen: {{red_flags_neuro_screen}}. Sleep/mood/psychosocial context: {{psychosocial_sleep_mood}}. Preferences/affordability/priorities: {{patient_preferences_affordability}}.

History-based impression/plan: {{history_impression_plan}} {{history_followup_phrase}}

Physician review required before signing in the EMR. Verify actual medications, doses, lot/expiry, devices, image documentation, response, complications, and follow-up.