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Initial Patient Complaint
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Return Patient
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Chief Complaint
• • •
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Present Medical
• • •
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Chief Complaint Female
• • •
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Medical Conditions Other
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Accident/Injury Date
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Duration
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LU Deficient Heat
• • •
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Yin Qiao - Ren Mai Manaka
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SP Deficient Heat
• • •
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Ren Mai - Yin Qiao Imbalance
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KD Deficient Heat
• • •
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Yin Wei - Chong Mai Manaka
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LR Deficient Heat
• • •
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Yang Qiao - Du Mai Manaka
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SP Deficient LR Excess Heat
• • •
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Yang Wei - Dai Mai Manaka
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SP Deficient LR Blood Stasis
• • •
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Cross Syndrome Manaka
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SP Deficient LU Excess Heat
• • •
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LU Deficient LR Blood Stasis
• • •
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Oketsu
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Immune
• • •
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SP Deficient Cold
• • •
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ANS Nagano Style
• • •
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New Field
• • •
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Zong Qi
• • •
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KD Deficient Cold
• • •
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Inguinal Tension
• • •
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New Field
• • •
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Basilar Artery
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LU Deficient Cold
• • •
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Inner Thigh
• • •
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LR Deficient Cold
• • •
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SP/KD Deficient Cold
• • •
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Shigo
• • •
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Tung Method
• • •
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Tung Method Detailed
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Supplemental Acupuncture by Region
• • •
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French Acupuncture
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Shiraku
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Kyutoshin
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KiKei Treatment
• • •
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Teate/Sotai
• • •
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Tonetsu-kyu Detailed
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Blue Poppy Classics
• • •
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Kampo
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Kampo
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Assessment
• • •
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Total Time Spent
• • •
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Sig/Medical Authorization
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