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Subjective
Subjective
Subjective
Objective
Objective
Physical Exam Findings
No abnormal physical exam findings
General Comments
HEENT WNL
HEENT Comments
Neck WNL
Neck Comments
Cardiovascular WNL
Cardiovascular Comments
Lungs WNL
Lungs Comments
Abdomen WNL
Abdomen Comments
Extremities WNL
Extremity Comments
MSK WNL
MSK Comments
Cranial Neuro WNL
Cranial Neuro Comments
Skin WNL
Skin Comments
Psych WNL
Psych comments
Lab Results reviewed
Lab Results Reviewed Comments
Acupuncture Medicine Diagnosis
AIM Pattern Dx
• • •
Biopsychotype
Biopsychotype
Oriental Medical Diagnosis
Abdominal Diagnosis
Pulse
Tongue Diagnosis
Treatment
Auricular
Volf Auricular Dx
Root
• • •
Ear pic #1
Ear pic #2
Ear pic #3
Ear points
Which Ear?
Ear Stud type
Ear points
• • •
Additional Ear Points
Battlefield Acupuncture
ATP protocol
NADA Protocol
Homunculus Image
Local and Regional
Local and Regional with Point Selection
Local and Regional
• • •
Simple Neuromuscular Protocol
Extensive Neuromuscular Protocol
Energy Movement
Diagrams
Acupuncture picture
Yin Yang Drawing
Fire/Earth/Metal/Water/Wood
Principal
N/N +1
Shao-Yin/Tai-Yang
• • •
Tai-Yin/Yang-Ming
• • •
Jue-Yin/ Shao- Yang
• • •
Principal
Kidney
• • •
Kidney Energy Moving Points
• • •
Heart
• • •
Heart Energy Moving Points
• • •
Small Intestine
• • •
Small Intestine Energy Moving Points
• • •
Bladder
• • •
Bladder energy moving points
• • •
Liver
• • •
Liver Energy Moving Points
• • •
Pericardium/Master of the Heart
• • •
Pericardium/Master of the Heart
• • •
Triple Heater/Warmer
• • •
Triple Heater/Warmer Energy Moving Points
• • •
Gallbladder
• • •
Gallbladder Energy Moving Points
• • •
Spleen
• • •
Spleen Energy Moving Points
• • •
Lung
• • •
Lung Energy Moving Points
• • •
Large Intestine
• • •
Large Intestine Energy Moving Points
• • •
Stomach
• • •
Stomach Energy Moving Points
• • •
Conception Vessel/Ren Mo
• • •
Governor Vessel/Du Mo
• • •
Distinct
Distinct
DM diagram
KI-BL
• • •
LR-GB
• • •
SP-ST
• • •
SI-HT
• • •
TW-PC
• • •
LI-LU
• • •
Curious
Curious
Curious Diagram
Chong Mo
• • •
Dai Mo
• • •
Yin Wei
• • •
Yang Wei
• • •
Yin Qiao
• • •
Yang Qiao
• • •
Ren Mo Helms
• • •
Du Mo Helms
• • •
Ren Mai Volf
• • •
Du Mai Volf
• • •
Other Curious Points
• • •
Tendinomuscular
Tendinomuscular
Tendinomuscular Area
TM diagram
Ting Points
• • •
Gathering Points
• • •
Specialized Protocols
Specialized Protocols
Mu Shu
Mu Shu
Mu
• • •
Shu
• • •
Hui Points
• • •
Tan
Tan Simple Treatments
Low back and neck ipsilateral
Low back and neck Contralateral
Abdomen
Face
Tan Fatigue Treatment
Tan Insomnia Treatment
Tan Viral Illness treatment
Tan Anxiety Treatment
Tan Complex Treatment
Tan comments
Japanese Needling
Japanese Needling point selection
• • •
Japanese Needling location
Cerebral
Cerebral Circulation choices
• • •
Dragons I/E
Windows of the Sky
Windows of the Sky choices
• • •
Scalp
GV star/Si Shen Cong
Ba Feng Points
Ba Feng laterality
Ba Xie points
Ba Xie laterality
Scar deactivation
Scar location
CV-GV
4 Needle
Niemtzow Salivary Technique
Rong Qi Circulation/Acupuncture Clock
Other Points
Energy Stimulation
Moxa
FSM
FSM #1
FSM #1 program
FSM #1 Frequency (mHz) / Area
/
FSM #2
FSM #2 program
FSM #2 Frequency (mHz) /area
/
FSM with ACE
FSM with ACE program
FSM with ACE Frequency (mHz) /area
/
FSM NO CHARGE
FSM No Charge program
FSM No Charge Frequency (mHz) /area
/
Electrical Stimulation
E-stim points (- to +)
E-stim frequency
TENS / PENS
Cervical Pens
Lumbar Pens
Localized joint treatment
Laterality
• • •
Electrical Stimulation
• • •
Ankle
• • •
Knee
• • •
Shoulder
• • •
Elbow
• • •
Wrist
• • •
Hip
• • •
Cervical
• • •
Lumbar
• • •
Other
Ion Cords
Ion Cord Points
Cupping
Cupping
Cup location
• • •
Assessment
Assessment:
Plan
Plan/Notes
Follow up
Supervising Physician
Supervising Physician

Acupuncture Note Medical Form

Integrative and Functional Medicine

There are 7 copies in use.
Published: March 13, 2018, 11:13 p.m.
Doctor: Dr. History Physical
Rating: 0   /

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Sunnyvale, CA 94089

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