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Labs
• • •
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Lab Comments
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Psychotherapy
• • •
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Psychotherapy Referral Comments
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Education & Counseling
• • •
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Mind Body Skills
• • •
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Education
• • •
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Education Comments
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Nutrition
• • •
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Nutrition Comments
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Other Referrals
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Referral Comments
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Radiology
• • •
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Radiology Comments
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General Instructions
• • •
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General Instruction Comments
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Reviewed & Discussed Medication/Supplement risks/benefits/Side effects/interactions/alternatives?
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Patient indicates understanding and agreement with current treatment plan?
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Physician Attestation to Ketamine Informed Consent
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|
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PDMP Checked and alerts discussed with patient?
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Return appt
• • •
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Additional Comments
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New Free Draw
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