| Diagnosis _1• • • | Number of Injections _2 | 
| Locations of Injections _3• • • | Type of Cleansing Agent _4• • • | 
| Needle size? _5 | Concentration of Lidocaine? _6 | 
| Steroid Concentration _7 | Type of Steroid _8 | 
| Volume of Injectate _9 | Location of Injections _10• • • | 

