|
B12 Injection
|
B12 Location
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Cupping Location
|
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Cupping Start Time
|
Cupping Duration (min's.)
|
|
|
|
|
TDP Location
|
|
|
TDP Start Time
|
TDP Duration (min's.)
|
|
|
|
|
Trigger Point Injectables
|
Trigger Point Quantity
|
|
Trigger Point Muscle Groups
• • •
|
|
|
|
|
|
Cosmetic Injectables
• • •
|
Condition Improvement
• • •
|
|
Cosmetic Injection Location
|
Cosmetic Injection Purpose
|
|
|
|
|
Massage Location
|
|
|
Massage Start Time
|
Massage Duration (min's.)
|
|
|
|
|
Exercise Start Time
|
Exercise Duration (min's.)
|
|
Exercise
• • •
|
|
|
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|
Additional Recommendations
|
|
|
|
|
|
Labs
• • •
|
Lab Comments
|
|
Radiology
• • •
|
Radiology Comments
|
|
PT Recommendations
|
PT Recommendation Comments
|
|
Home Health
• • •
|
Home health comments
|
|
Referrals
|
Referral Comments
|
|
Education
|
Education Comments
|
|
Diet
|
Diet Comments
|
|
General Instructions
• • •
|
General Instruction Comments
|
|
Time Inserted/Minutes Retained
/
|
|
