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Subjective
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Subjective
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Subjective
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Objective
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Objective
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|
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Physical Exam Findings
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No abnormal physical exam findings
|
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General Abnormal
• • •
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General Comments
|
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HEENT WNL
|
HEENT Abnormal
• • •
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|
HEENT Comments
|
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Neck WNL
|
Neck Abnormal
• • •
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Neck Comments
|
|
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Cardiovascular WNL
|
Cardiovascular Abnormal
• • •
|
|
Cardiovascular Comments
|
|
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Lungs WNL
|
Lungs Abnormal
• • •
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Lungs Comments
|
|
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Abdomen WNL
|
Abdomen Abnormal
• • •
|
|
Abdomen Comments
|
|
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Extremities WNL
|
Extremity Abnormal
• • •
|
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Extremity Comments
|
|
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MSK WNL
|
MSK Abnormal
• • •
|
|
MSK Comments
|
|
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Cranial Neuro WNL
|
Cranial Neuro Abnormal
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|
Cranial Neuro Comments
|
|
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Skin WNL
|
Skin Lesion
|
|
Skin Comments
|
|
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Lab Results reviewed
|
Lab Results Reviewed Comments
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Acupuncture Medicine Diagnosis
|
Biopsychotype
|
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Fire Child Water Child type
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Volf Auricular Dx
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Root
• • •
|
Ear pic #1
|
|
Ear pic #2
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Ear pic #3
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Treatment
|
Ear points
|
|
Ear Stud type
|
Which Ear?
|
|
Ear points
• • •
|
Additional Ear Points
|
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Battlefield Acupuncture
|
ATP protocol
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Shonishin Treatment
|
Instrument Choice
• • •
|
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Type of Shonishin treatment
• • •
|
Core/Basic Treatment
|
|
Pattern Based Root Treatment
|
Side treated
|
|
Pattern Diagram
|
Pattern
• • •
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|
Shonishin Treatment notes
|
|
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Qi Gong Massage
|
|
|
Cupping
|
Cup location
• • •
|
|
Traditional Treatments
|
|
|
Traditional Patterns
|
Instrument
• • •
|
|
Acupuncture picture
|
Yin Yang Drawing
|
|
5 Phase
|
Fire/Earth/Metal/Water/Wood
|
|
Command points
|
|
|
Time of treatment (min) for needles
|
N/N +1
|
|
Shao-Yin/Tai-Yang
• • •
|
Tai-Yin/Yang-Ming
• • •
|
|
Jue-Yin/ Shao- Yang
• • •
|
Curious
|
|
Curious Diagram
|
Chong
• • •
|
|
Yin Wei
• • •
|
Dai
• • •
|
|
Yang Wei
• • •
|
Ren Mai
• • •
|
|
Yin Qiao
• • •
|
Du Mai
• • •
|
|
Yang Qiao
• • •
|
Other Curious Points
• • •
|
|
Distinct
|
DM diagram
|
|
KI-BL
• • •
|
LR-GB
• • •
|
|
SP-ST
• • •
|
SI-HT
• • •
|
|
TW-PC
• • •
|
LI-LU
• • •
|
|
Cerebral
|
Cerebral Circulation choices
• • •
|
|
GV star/Si Shen Cong
|
Dragons I/E
|
|
Moxa
|
Rong Qi Circulation
|
|
Windows of the Sky
|
Windows of the Sky choices
• • •
|
|
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
|
|
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
• • •
|
CV Frequently Used Points
• • •
|
|
Governor Vessel/Du Mo
• • •
|
Governor Vessel Frequently Used Points
• • •
|
|
Ba Feng Points
|
Ba Feng laterality
|
|
Ba Xie points
|
Ba Xie laterality
|
|
Four needle technique
|
Sedate or tonify
|
|
Organ
• • •
|
Four needle points
|
|
Other Points
|
|
|
Assessment
|
|
|
Assessment:
|
|
|
Plan
|
|
|
Plan/Notes
|
Follow up
|
|
Supervising Physician
|
Name of Physician
• • •
|
