|
Blood Pressure
/
|
Pulse BPM
|
|
Right Pulse
• • •
|
Left Pulse
• • •
|
|
Tongue
• • •
|
|
|
|
|
|
Phys Findings 1
• • •
|
Location 1
• • •
|
|
Phys Findings 2
• • •
|
Location 2
• • •
|
|
Beh Observ
• • •
|
Facial Observation
• • •
|
|
|
|
|
ROM tests?
|
Previous ROM
|
|
ROM Body Part
|
% and Pain #
|
|
ROM Body Part
|
% and Pain #
|
|
ROM Body Part
|
% and Pain #
|
|
ROM Body Part
|
% and Pain #
|
|
ROM Body Part
|
% and Pain #
|
|
ROM Body Part
|
% and Pain #
|
|
ROM Body Part
|
% and Pain #
|
|
ROM Body Part
|
% and Pain #
|
|
ROM of Body Part
|
% and Pain #
|
|
ROM of Body Part
|
% and Pain #
|
|
Comments
|
|
|
|
|
|
CPT #1
|
Start & End Time
/
|
|
Point Combinations
• • •
|
Motor Points
• • •
|
|
Esoteric Acupuncture
• • •
|
Bilaterally
|
|
Auricular Points
• • •
|
Left
|
|
Facial Rejuvenation Acupuncture
• • •
|
Right
|
|
Comments
|
|
|
97813
/
|
97813
/
|
|
97813
/
|
97813
/
|
|
|
|
|
CPT #2
|
Start & End Time
/
|
|
Point Combinations
• • •
|
Motor Points
• • •
|
|
Esoteric Acupuncture
• • •
|
Bilaterally
|
|
Auricular Points
• • •
|
Left
|
|
Facial Rejuvenation Acupuncture
• • •
|
Right
|
|
Comments
|
|
|
97814
/
|
97814
/
|
|
97814
/
|
97814
/
|
|
|
|
|
CPT #3
|
Start & End Time
/
|
|
Point Combinations
• • •
|
Motor Points
• • •
|
|
Esoteric Acupuncture
• • •
|
Bilaterally
|
|
Auricular Points
• • •
|
Left
|
|
Facial Rejuvenation Acupuncture
• • •
|
Right
|
|
Comments
|
|
|
97814
/
|
97814
/
|
|
97814
/
|
97814
/
|
|
|
|
|
CPT #4
|
Start and End Time
/
|
|
Point Combinations
• • •
|
Motor Points
• • •
|
|
Esoteric Acupuncture
• • •
|
Bilaterally
|
|
Auricular Points
• • •
|
Left
|
|
Facial Rejuvenation Acupuncture
• • •
|
Right
|
|
Comments
|
|
|
97814
/
|
97814
/
|
|
97814
/
|
97814
/
|
|
|
|
|
NAET
|
NAET Last Item Treated
|
|
NAET Last Item Clear?
|
NAET Emotion
|
|
NAET
|
NAET Other Items
|
|
|
|
|
Acupuncture
|
Acupuncture units
|
|
Infrared Heat Lamp
|
Infrared Heat Units
|
|
Gua Sha
|
Gua Sha Location
• • •
|
|
Moxa
|
Moxa Location
|
|
Cupping
|
Cupping Location
• • •
|
|
Tuning Forks
|
Tuning Fork Location
|
|
Tui na
|
Sho-Ni-Shin
|
|
Aroma Acupoint Therapy
• • •
|
Aroma Acupoint Therapy™ Addl
|
|
|
|
|
Essential Oils
|
Essential Oil(s) A-C
• • •
|
|
Essential Oil(s) D-G
• • •
|
Essential Oil(s) H-L
• • •
|
|
Essential Oil(s) M-P
• • •
|
Essential Oil(s)R-Z
• • •
|
