|
Labs
• • •
|
Lab Comments
|
|
Imaging- MRI
• • •
|
Imaging Comments
|
|
Therapy
• • •
|
Therapy Comments
|
|
Injections
• • •
|
Injection Level
• • •
|
|
Injection comments
|
|
|
Surgery
• • •
|
Surgical Level
• • •
|
|
Surgery comments
|
Surgery request
• • •
|
|
Non-operative methods tried
• • •
|
Informed consent and decision
• • •
|
|
Items to be completed prior to s
• • •
|
|
|
Items to be completed:
• • •
|
Lab Comments
|
|
Electrodiagnostics
• • •
|
Electrodiagnostic comments
|
|
Medications
• • •
|
Medication comments
|
|
Nutrition
• • •
|
Diet Comments
|
|
Home Health
• • •
|
Home health comments
|
|
Referrals
|
Referral Comments
|
|
General Instructions
• • •
|
General Instruction Comments
|
|
Education
|
Education Comments
|
|
|
|
|
Cc:
|
|
