MIBRAR® / Treatment request
Treatment request
To respond to your request, you need to fill out the questionnaire and send radiological images of the relevant pathology area (in .dicom format) as well as any other required examination results.
Area of pathology
Side *
Current complaints
Do you have pain? *
Pain
Pain level (0 = none, 10 = unbearable) *
Localizability *
Where is it located? *
Spread *
Direction of radiation? *
Type of pain *
Do you have a sensory disturbance? *
Sensory disturbance
Sensations *
Location of sensory loss *
Do you have a motor disturbance? *
Motor disturbance
Symptoms *
Location of motor disturbance *
Degree of reduced strength (0 = none, 10 = severe) *
Do you have restricted movement? *
Movement restrictions
Which movements are restricted? *
Which movements are restricted? *
Course over time
Duration of complaints
When the complaints first appeared *
Were there flare-ups? *
Period of worsening of complaints: from *
Period of worsening of complaints: to *
Was there any relief? *
Period of relief of complaints: from *
Period of relief of complaints: to *
Circumstances of the complaints
When the complaints occur *
Circumstances of changes in the complaints
Under what circumstances the complaints get worse *
Under what circumstances the complaints ease *
Frequency
How often *
Changes
How the condition has changed overall *
Limitations in life
Where limitations are felt *
Other limitations *
Treatment history
Established diagnosis
When *
Which *
Conservative treatments
When *
Which *
Result *
Surgeries
When *
Which *
Result *
What are the further treatment recommendations?
Conservative treatment methods *
Surgical treatment methods *
Accompanying factors
Other accompanying diseases *
Currently used medication *
Currently used treatments *
Is there another area that troubles you?