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Home New patient-99343
Home Established Patient 99347
Home New patient-99344
Home Established patient-99348
Home New Patient-99345
Home Established patient-99349
AL New patient-99327
Home Established patient-99350
AL New patient-99328
AL Established patient-99335
Care plan Oversight Simple 99339
AL Established patient-99336
Care Plan Oversight complex 99340
AL Established patient-99337
Transition Care
• • •
Free text: Release date
Continue current treatment plan
Free Text:Treatment Plan Comment
Time
• • •
General Instructions
• • •
General Instruction Comments
Education provided to patient
• • •
Education comments:
Referrals
Referral Comments
Home Health
• • •
Home health comments
Diet
Diet Comments
PT Recommendation Comments
Procedure done:
• • •
Injection Given?
Med administered by:
Medication: injection
• • •
Location given:
Expiration date details
Medication Lot details
Vaccination: Flu Vaccine
Procedure: Neb treatment
Imaging Orders
Free text: re test ordered
Labs ordered
Free text: re labs ordered
Referrals
Free text:ref: Home health, DME
Procedure: Burn Debridement
Procedure: Burn Treatment
Procedure: Cerumen Impaction
Procedure: I&D Abscess
Procedure: Simple Repair, Lac.
Procedure: 1 layer Wound Facial
Procedure: Ingrown nail, partial
Procedure: Wound Debridement
Procedure: Nail Trephinaton
Procedure: Superficial Wound Rep
Procedure: Wedge Excision of Nai
Mole Removal 1.1cm to 2.0cm
Procedure: Complete Nail Removal
Mole Removal >2.0cm
Application of Finger Splint
Procedure: Foreign Body Eye Exam

Procedures and Instructions Medical Form

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Published: Nov. 27, 2015, 7:21 p.m.
Doctor: Dr. History Physical
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