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LUMBAR SPINE QUESTIONNAIRE Dr. Matsubara Please print legibly in black ink. This form will become a part of your medical record. PART 1: GENERAL INFORMATION 1) Name: 2) Today's Date: 3) Date of birth:Age:Gender:4)
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To fill out the lumbar spine questionnaire, follow these steps:
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Start by reading the instructions provided with the questionnaire. This will give you an overview of the purpose and structure of the questionnaire.
03
Find a quiet and comfortable space to fill out the questionnaire. Make sure you have enough time and focus to complete it.
04
Carefully read each question and understand what it is asking. If you have any doubts, refer to the instructions or seek clarification from a healthcare professional.
05
Answer each question honestly and to the best of your ability. Avoid guessing or making assumptions.
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Use the provided response options or fill in the blank spaces as instructed. If a question does not apply to you, indicate it accordingly.
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Take breaks if needed. It's important to maintain concentration throughout the questionnaire.
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Review your answers before submitting. Double-check for any errors or missing information.
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Submit the completed questionnaire as instructed, whether it's through online submission or returning a physical copy to the designated recipient.

Who needs lumbar spine questionnairedr?

01
The lumbar spine questionnaire is needed by individuals who are experiencing or have a history of lumbar spine issues. It is commonly used in medical settings, such as clinics or hospitals, to assess a patient's symptoms, functional limitations, and overall well-being related to the lumbar spine region.
02
This questionnaire is typically given to patients who are seeking medical evaluation or treatment for conditions such as lower back pain, herniated discs, spinal stenosis, or degenerative disc disease.
03
The questionnaire helps healthcare professionals gather important information about a patient's condition, track changes over time, and make informed decisions regarding treatment plans or interventions. It is an essential tool for assessing and monitoring lumbar spine health.
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The lumbar spine questionnaire is a form used to gather information about issues related to the lower back.
Individuals who are experiencing lower back pain or have been diagnosed with a lumbar spine condition are required to fill out the lumbar spine questionnaire.
To fill out the lumbar spine questionnaire, individuals need to provide information about their medical history, symptoms, and any previous treatments they have received for their lower back issues.
The purpose of the lumbar spine questionnaire is to help healthcare providers better understand a patient's lower back problems and determine the most appropriate treatment plan.
The lumbar spine questionnaire may require information about the patient's medical history, symptoms, daily activities, and any previous treatments or surgeries related to their lower back.
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