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Consents For Treatment
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Are All Consents Signed
|
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Expectations & Rights
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Massage Therapy Consent
|
|
|
|
|
Preformatted Notes
|
Full Body Diagram
|
|
General Spinal Therapy | 60 Minutes
|
General Spinal Therapy | 90 Minutes
|
|
|
|
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SUBJECTIVE PROFILE
|
|
|
Location Of Primary Complaint(s)
• • •
|
Pain Scale
• • •
|
|
Description Of Symptom(s)
• • •
|
Timing
• • •
|
|
What Helps Symptom(s)
• • •
|
What Makes Symptom(s) Worse?
• • •
|
|
Additional Notes (Dictate)
|
|
|
|
|
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OBJECTIVE FINDINGS / TREATMENT PROCEDURES
|
|
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Cervical / Thoracic Spine
|
C/s Posterior
|
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Neck Musculature
• • •
|
Adhesions/Trigger Points
• • •
|
|
Treatment Duration For This Region(s)
|
Additional Notes (Dictate)
|
|
|
|
|
Lumbar Spine / Pelvis
|
L/s Pelvic Muscle Diagram
|
|
Lumbar Spine / Pelvic Musculature
• • •
|
Adhesions | Trigger Points
• • •
|
|
Treatment Duration For This Region(s)
|
Additional Notes (Dictate)
|
|
|
|
|
Upper Extremity
|
Muscle Diagram
|
|
Upper Extremity Musculature
• • •
|
TrPs:
• • •
|
|
Treatment Duration For This Region(s)
|
Additional Notes (Dictate)
|
|
|
|
|
Lower Extremity
|
Muscle Diagram
|
|
Lower Body Musculature
• • •
|
Adhesions/Trigger Points
• • •
|
|
Treatment Duration For This Region(s)
|
Additional Notes (Dictate)
|
|
|
|
|
Assessment: Post Treatment
|
|
|
Response To Treatment
• • •
|
Next Patient Visit
• • •
|
|
Progress Affected By
• • •
|
Homecare Recommendations
• • •
|
|
|
|
|
Plan
|
|
|
Treatment Techinques
|
|
|
Myofascial Release
|
Cupping
|
|
Longitudinal gliding
|
Trigger Point Therapy
|
|
PNF Stretches
|
Cross-Fiber Massage
|
|
Kinesiology Tape
• • •
|
|
|
|
|
|
Referrals
|
|
|
Chiropractic Care
|
Acupuncture
|
|
Physical Therapy
|
Medical Doctor
|
|
Pilates
|
|
