Pre-Treatment
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Consents/Pictures
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Skin Assessment
• • •
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Area 1
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Treatment #
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Area 2
• • •
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Treatment #
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Area 3
• • •
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Treatment #
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Area 4
• • •
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Treatment #
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Treatment Settings
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Pass#1
• • •
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Other Treatment Zone
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Fluence
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Pulse Type
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Cooling
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Repeat Mode
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Total Pulses
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Details
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Pass #2
• • •
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Other Treatment Zone
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Fluence
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Pulse Type
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Cooling
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Repeat Mode
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Total Pulses
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Details
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Pass #3
• • •
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Other Treatment Zone
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Fluence
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Pulse Type
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Cooling
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Repeat Mode
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Total Pulses
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Details
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Treatment Summary
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Total Pulses For Entire Treatment
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Treatment Response
• • •
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Patient Education
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Staff to Complete Procedure
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