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Patient Name and Date
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Subjective
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Patient's Subjective Findings
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Objective
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General/Facial Appearance
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Facial Picture
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Pulse: BPM
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Pulse: Overall Quality
• • •
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Left
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Cun:
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Guan:
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Chi:
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Right
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Cun:
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Guan:
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Chi:
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Tongue Description:
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Body:
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Tongue Picture
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Fur:
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Veins:
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Relevant Physical Findings
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Assessment
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Oriental Medicine Diagnosis
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General Thoughts
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Supporting Evidence
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Problem List
• • •
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Plan
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Treatment Principle
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Acupuncture Given
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Acupuncture Points
• • •
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Acupuncture Characteristics
• • •
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Patient Education
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Resources
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