{"id":6210,"date":"2025-05-22T09:22:20","date_gmt":"2025-05-22T07:22:20","guid":{"rendered":"https:\/\/vanlentsystems.com\/standard-case-report\/"},"modified":"2025-05-22T09:22:20","modified_gmt":"2025-05-22T07:22:20","slug":"standard-case-report","status":"publish","type":"page","link":"https:\/\/vanlentsystems.com\/en\/standard-case-report\/","title":{"rendered":"Standard Case Report"},"content":{"rendered":"<div class=\"forminator-ui forminator-custom-form forminator-custom-form-6206 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-6206\" data-uid=\"69f3829144ccd\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-6206\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-6206 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"6206\"\n\t\t\t\t data-color-option=\"theme\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"69f3829144ccd\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Standard Case Report<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-3\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Patient Information<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-69f3829144ccd-label\"><span id=\"forminator-radiogroup-radio-1-69f3829144ccd-label\" class=\"forminator-label\">Sex at birth <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-69f3829144ccd\" class=\"forminator-radio forminator-radio-inline\" title=\"Female\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-69f3829144ccd\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Female<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-69f3829144ccd\" class=\"forminator-radio forminator-radio-inline\" title=\"Male\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-69f3829144ccd\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Male<\/span><\/label><\/div><\/div><div id=\"number-1\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_69f3829144ccd\" id=\"forminator-field-number-1_69f3829144ccd-label\" class=\"forminator-label\">Age <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-1\" value=\"\" placeholder=\"\" id=\"forminator-field-number-1_69f3829144ccd\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"0\" max=\"150\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-1\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Complaint \/ Reason for TENS (Select all that apply)<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-69f3829144ccd-label\"><label id=\"forminator-field-checkbox-1-1-69f3829144ccd-label\" for=\"forminator-field-checkbox-1-1-69f3829144ccd\" class=\"forminator-checkbox\" title=\"Medication is ineffective\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Medication-is-ineffective\" id=\"forminator-field-checkbox-1-1-69f3829144ccd\" aria-labelledby=\"forminator-field-checkbox-1-1-69f3829144ccd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Medication is ineffective<\/span><\/label><label id=\"forminator-field-checkbox-1-2-69f3829144ccd-label\" for=\"forminator-field-checkbox-1-2-69f3829144ccd\" class=\"forminator-checkbox\" title=\"Medication causes too many side effects\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Too-many-side-eefects\" id=\"forminator-field-checkbox-1-2-69f3829144ccd\" aria-labelledby=\"forminator-field-checkbox-1-2-69f3829144ccd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Medication causes too many side effects<\/span><\/label><label id=\"forminator-field-checkbox-1-3-69f3829144ccd-label\" for=\"forminator-field-checkbox-1-3-69f3829144ccd\" class=\"forminator-checkbox\" title=\"Impaired functioning\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Impaired-functioning\" id=\"forminator-field-checkbox-1-3-69f3829144ccd\" aria-labelledby=\"forminator-field-checkbox-1-3-69f3829144ccd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Impaired functioning<\/span><\/label><label id=\"forminator-field-checkbox-1-4-69f3829144ccd-label\" for=\"forminator-field-checkbox-1-4-69f3829144ccd\" class=\"forminator-checkbox\" title=\"Other\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Other\" id=\"forminator-field-checkbox-1-4-69f3829144ccd\" aria-labelledby=\"forminator-field-checkbox-1-4-69f3829144ccd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Other<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69f3829144ccd\" id=\"forminator-field-text-1_69f3829144ccd-label\" class=\"forminator-label\">Other reason <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_69f3829144ccd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-4\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Cause of Complaint<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_69f3829144ccd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-2\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Pain Type<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-69f3829144ccd-label\"><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-69f3829144ccd\" class=\"forminator-radio\" title=\"Acute pain\"><input type=\"radio\" name=\"radio-2\" value=\"Acute\" id=\"forminator-field-radio-2-1-69f3829144ccd\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Acute pain<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-69f3829144ccd\" class=\"forminator-radio\" title=\"Chronic pain\"><input type=\"radio\" name=\"radio-2\" value=\"Chronic\" id=\"forminator-field-radio-2-2-69f3829144ccd\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Chronic pain<\/span><\/label><label id=\"forminator-field-radio-2-label-3\" for=\"forminator-field-radio-2-3-69f3829144ccd\" class=\"forminator-radio\" title=\"Mixed pain type\"><input type=\"radio\" name=\"radio-2\" value=\"Mixed\" id=\"forminator-field-radio-2-3-69f3829144ccd\" aria-labelledby=\"forminator-field-radio-2-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Mixed pain type<\/span><\/label><label id=\"forminator-field-radio-2-label-4\" for=\"forminator-field-radio-2-4-69f3829144ccd\" class=\"forminator-radio\" title=\"Nociceptive pain\"><input type=\"radio\" name=\"radio-2\" value=\"Nociceptive\" id=\"forminator-field-radio-2-4-69f3829144ccd\" aria-labelledby=\"forminator-field-radio-2-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Nociceptive pain<\/span><\/label><label id=\"forminator-field-radio-2-label-5\" for=\"forminator-field-radio-2-5-69f3829144ccd\" class=\"forminator-radio\" title=\"Neuropathic pain\"><input type=\"radio\" name=\"radio-2\" value=\"Neuropathic\" id=\"forminator-field-radio-2-5-69f3829144ccd\" aria-labelledby=\"forminator-field-radio-2-label-5\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Neuropathic pain<\/span><\/label><label id=\"forminator-field-radio-2-label-6\" for=\"forminator-field-radio-2-6-69f3829144ccd\" class=\"forminator-radio\" title=\"Visceral pain\"><input type=\"radio\" name=\"radio-2\" value=\"Visceral\" id=\"forminator-field-radio-2-6-69f3829144ccd\" aria-labelledby=\"forminator-field-radio-2-label-6\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Visceral pain<\/span><\/label><label id=\"forminator-field-radio-2-label-7\" for=\"forminator-field-radio-2-7-69f3829144ccd\" class=\"forminator-radio\" title=\"Not applicable\"><input type=\"radio\" name=\"radio-2\" value=\"Not-applicable\" id=\"forminator-field-radio-2-7-69f3829144ccd\" aria-labelledby=\"forminator-field-radio-2-label-7\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Not applicable<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_69f3829144ccd\" id=\"forminator-field-textarea-1_69f3829144ccd-label\" class=\"forminator-label\">Anamnesis<\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_69f3829144ccd\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-5\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Previous Treatments<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;List Another Treatment&quot;,&quot;remove_text&quot;:&quot;Remove Treatment&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_69f3829144ccd\" id=\"forminator-field-text-3_69f3829144ccd-label\" class=\"forminator-label\">Treatment (incl. duration of treatment)<\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_69f3829144ccd\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_69f3829144ccd\" id=\"forminator-field-text-4_69f3829144ccd-label\" class=\"forminator-label\">Treatment Outcome<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_69f3829144ccd\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"List Another Treatment\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove Treatment\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-6\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">TENS Treatment<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_69f3829144ccd\" id=\"forminator-field-text-5_69f3829144ccd-label\" class=\"forminator-label\">Application <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"E.g. Th. 1 - 3 and L4 - S1.\" id=\"forminator-field-text-5_69f3829144ccd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_69f3829144ccd\" id=\"forminator-field-text-6_69f3829144ccd-label\" class=\"forminator-label\">Electrode shape and size <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"E.g. Round 4x4cm.\" id=\"forminator-field-text-6_69f3829144ccd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_69f3829144ccd\" id=\"forminator-field-text-7_69f3829144ccd-label\" class=\"forminator-label\">Program <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"E.g. P1, P2, HAN, Conventional TENS.\" id=\"forminator-field-text-7_69f3829144ccd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-8\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_69f3829144ccd\" id=\"forminator-field-text-8_69f3829144ccd-label\" class=\"forminator-label\">Treatment Schedule <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"E.g. Once daily.\" id=\"forminator-field-text-8_69f3829144ccd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-9\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_69f3829144ccd\" id=\"forminator-field-text-9_69f3829144ccd-label\" class=\"forminator-label\">Session Duration <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"E.g. 45 Minutes.\" id=\"forminator-field-text-9_69f3829144ccd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-7\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">TENS Treatment Outcome (Select all that apply)<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-2-69f3829144ccd-label\"><label id=\"forminator-field-checkbox-2-1-69f3829144ccd-label\" for=\"forminator-field-checkbox-2-1-69f3829144ccd\" class=\"forminator-checkbox\" title=\"Reduced pain\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Reduced-pain\" id=\"forminator-field-checkbox-2-1-69f3829144ccd\" aria-labelledby=\"forminator-field-checkbox-2-1-69f3829144ccd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Reduced pain<\/span><\/label><label id=\"forminator-field-checkbox-2-2-69f3829144ccd-label\" for=\"forminator-field-checkbox-2-2-69f3829144ccd\" class=\"forminator-checkbox\" title=\"Reduced medication use\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"two\" id=\"forminator-field-checkbox-2-2-69f3829144ccd\" aria-labelledby=\"forminator-field-checkbox-2-2-69f3829144ccd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Reduced medication use<\/span><\/label><label id=\"forminator-field-checkbox-2-3-69f3829144ccd-label\" for=\"forminator-field-checkbox-2-3-69f3829144ccd\" class=\"forminator-checkbox\" title=\"Improved functioning\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Improved-functioning\" id=\"forminator-field-checkbox-2-3-69f3829144ccd\" aria-labelledby=\"forminator-field-checkbox-2-3-69f3829144ccd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Improved functioning<\/span><\/label><label id=\"forminator-field-checkbox-2-4-69f3829144ccd-label\" for=\"forminator-field-checkbox-2-4-69f3829144ccd\" class=\"forminator-checkbox\" title=\"Other\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Other\" id=\"forminator-field-checkbox-2-4-69f3829144ccd\" aria-labelledby=\"forminator-field-checkbox-2-4-69f3829144ccd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Other<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-2\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_69f3829144ccd\" id=\"forminator-field-number-2_69f3829144ccd-label\" class=\"forminator-label\">VAS (cm) before treatment<\/label><input name=\"number-2\" value=\"\" placeholder=\"\" id=\"forminator-field-number-2_69f3829144ccd\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"0\" max=\"10\" \/><\/div><\/div><div id=\"number-3\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-3_69f3829144ccd\" id=\"forminator-field-number-3_69f3829144ccd-label\" class=\"forminator-label\">VAS (cm) after treatment<\/label><input name=\"number-3\" value=\"\" placeholder=\"\" id=\"forminator-field-number-3_69f3829144ccd\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"0\" max=\"10\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-10\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-10_69f3829144ccd\" id=\"forminator-field-text-10_69f3829144ccd-label\" class=\"forminator-label\">Other outcome <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-10\" value=\"\" placeholder=\"\" id=\"forminator-field-text-10_69f3829144ccd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_69f3829144ccd\" id=\"forminator-field-textarea-2_69f3829144ccd-label\" class=\"forminator-label\">TENS Side Effects<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_69f3829144ccd\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_69f3829144ccd\" id=\"forminator-field-textarea-3_69f3829144ccd-label\" class=\"forminator-label\">Questions or comments regarding this case<\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_69f3829144ccd\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-8\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Therapist Information<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_69f3829144ccd\" id=\"forminator-field-name-1_69f3829144ccd-label\" class=\"forminator-label\">Therapist Name<\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_69f3829144ccd\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_69f3829144ccd\" id=\"forminator-field-date-1-picker_69f3829144ccd-label\" class=\"forminator-label\">Date <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"Current Date\" id=\"forminator-field-date-1-picker_69f3829144ccd\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-11\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-11_69f3829144ccd\" id=\"forminator-field-text-11_69f3829144ccd-label\" class=\"forminator-label\">Facility \/ Institution<\/label><input type=\"text\" name=\"text-11\" value=\"\" placeholder=\"\" id=\"forminator-field-text-11_69f3829144ccd\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-13\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-13_69f3829144ccd\" id=\"forminator-field-text-13_69f3829144ccd-label\" class=\"forminator-label\">Department<\/label><input type=\"text\" name=\"text-13\" value=\"\" placeholder=\"\" id=\"forminator-field-text-13_69f3829144ccd\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-12\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-12_69f3829144ccd\" id=\"forminator-field-text-12_69f3829144ccd-label\" class=\"forminator-label\">City<\/label><input type=\"text\" name=\"text-12\" value=\"\" placeholder=\"\" id=\"forminator-field-text-12_69f3829144ccd\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-14\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-14_69f3829144ccd\" id=\"forminator-field-text-14_69f3829144ccd-label\" class=\"forminator-label\">Profession<\/label><input type=\"text\" name=\"text-14\" value=\"\" placeholder=\"\" id=\"forminator-field-text-14_69f3829144ccd\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-9\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Declarations<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><p>Van Lent Systems will use this case report solely for educational purposes, clinical evaluation, and\/or post-market surveillance. It will not be used for commercial or promotional purposes.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_69f3829144ccd\" id=\"forminator-field-name-2_69f3829144ccd-label\" class=\"forminator-label\">Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"\" id=\"forminator-field-name-2_69f3829144ccd\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-3-69f3829144ccd-label\" aria-describedby=\"forminator-radiogroup-radio-3-69f3829144ccd-description\"><span id=\"forminator-radiogroup-radio-3-69f3829144ccd-description\" class=\"forminator-description\">I consent to Van Lent Systems using this care report for educational purposes:<\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-69f3829144ccd\" class=\"forminator-radio\" title=\"With my name.\"><input type=\"radio\" name=\"radio-3\" value=\"one\" id=\"forminator-field-radio-3-1-69f3829144ccd\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-3-69f3829144ccd-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">With my name.<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-69f3829144ccd\" class=\"forminator-radio\" title=\"Without my name.\"><input type=\"radio\" name=\"radio-3\" value=\"two\" id=\"forminator-field-radio-3-2-69f3829144ccd\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-3-69f3829144ccd-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Without my name.<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-2\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><p>Thank you for your cooperation.<\/p><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Submit<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"c930a41695\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/6210\" \/><input type=\"hidden\" name=\"form_id\" value=\"6206\"><input type=\"hidden\" name=\"page_id\" value=\"6210\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/vanlentsystems.com\/en\/standard-case-report\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>\n","protected":false},"excerpt":{"rendered":"Standard Case ReportPatient InformationSex at birth *FemaleMaleAge *Complaint \/ Reason for TENS (Select all that apply)Medication is ineffectiveMedication causes too many side effectsImpaired functioningOtherOther reason *Cause of ComplaintPain TypeAcute painChronic painMixed pain typeNociceptive painNeuropathic painVisceral painNot applicableAnamnesisPrevious TreatmentsTreatment (incl. duration of treatment)Treatment OutcomeTENS TreatmentApplication *Electrode shape and size *Program *Treatment Schedule *Session Duration *TENS Treatment...","protected":false},"author":550,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"inline_featured_image":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-6210","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - 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