SOR Work Conditioning Phase 3 Documentation

Patient Identification & Session Timing

Used for CRM contact lookup, patient matching, and official session documentation.

All Fields Required

Patient First Name *

Patient Last Name *

Patient Email *

Patient Mobile Phone *

Session Date *

Start Time

End Time

Session Completion Progress:0 of 49 Exercises Completed (0%)

Exercise	Prescribed	Actual Duration
Forward Treadmill	10 min	min
Bike	10 min	min
UBE	10 min	min

All prescribed at 2 × 10

Exercise	Prescribed	Sets Done	Reps / Duration	Resistance / Tool
Putty Weight Bearing	3 × Red		—
Wrist Roller	3 sets		—	—
FlexBar — Radial/Ulnar Deviation	2 × Green
FlexBar — Wrist Flex/Extension	2 × Green
FlexBar — Pronation	2 × Green
FlexBar — Supination	2 × Green
Gripper (Calibrated)	5 min / 10 sec hold	—	min
Gripper (Red)	5 min / 10 sec hold per squeeze	—	min
Gripper (Blue Bands)	5 min / 10 sec hold	—	min

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Exercise	Prescribed	Reps / Distance Done	Weight / Resistance	Notes
Floor to Waist Lift	3 × 10 × 25 lbs		lbs
Leg Press	3 × 10 × 30 lbs		lbs	—
Deadlifts	3 × 10 × 20 lbs		lbs
Lunges	3 × 10		—
Lateral WalkingDistance	3 × 50 ft × Blue Bands	ft		—
Fwd/Bwd Combo WalkingDistance	3 × 50 ft	ft	lbs	—
Step Ups	3 × 10 × 20 lbs		lbs
Rows	3 × 10 × 35 lbs		lbs	—
Lat Pulldown	3 × 10 × 37 lbs		lbs	—
Reverse Flys	3 × 10 × Green Bands			—
Low Rows	3 × 10 × 35 lbs		lbs
Bicep Curls	3 × 10 × 20 lbs		lbs
Hammer Curls	3 × 10 × 20 lbs		lbs

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Exercise	Prescribed	Sets Done	Reps / Duration Done	Weight / Resistance
Low Rows	3 × 10 × 120 lbs			lbs
Upright Row	3 × 10 × 120 lbs			lbs
Farmer's Carry	5 min × 20 lbs	—	min	lbs

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Exercise	Prescribed	Actual Duration	Completed
Forward Treadmill	10 min	min
UBE	10 min	min

Therapist Notes

Pain Level Today (0 = No Pain, 10 = Worst Possible Pain)2 / 10

0 — No Pain3 — Mild5 — Moderate8 — Severe10 — Worst Pain

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SOR PT Gary, IN · Work Conditioning Phase 3 · Secure CRM Sync