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Assessment
• • •
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Assessment Dx
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MDT Class
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LS MDT Class
• • •
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CS MDT Class
• • •
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Ext MDT Class
• • •
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Manual Therapy
|
Manual Therapy
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Spinal CMT
• • •
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SMT Note
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Extremity CMT
• • •
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Extra-Spinal Note
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Myofascial Release Therapy
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Type of Manual Therapy
• • •
|
|
STM - Spine
• • •
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STM - Upper Extremity
• • •
|
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STM - Lower Extremity
• • •
|
Manual Therapy Note
|
|
|
Billable Time
|
|
IASTM
|
Same as
|
|
IASTM - Spine
• • •
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IASTM - Upper Extremity
• • •
|
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IASTM - Lower Extremity
• • •
|
IASTM Note
|
|
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Billable Time
|
|
TDN
• • •
|
TDN note
|
|
Massage Therapy
|
Same as
|
|
Massage Locations
• • •
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Billable Time
|
|
Cupping Therapy
|
Same as
|
|
Cupping Locations
• • •
|
Sha Marks
|
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No Sha Marks
|
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Manual Therapy Diagram
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|
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Tx in Office
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Rehab in Office
|
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Billable Time
|
PIR/Stretching
• • •
|
|
Mobilizations
• • •
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Re-enforcement
• • •
|
|
Other
|
|
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Passive Modalities
|
Passive Modalities
|
|
ES (X's on Therapy Picture)
• • •
|
Billable Time
|
|
US (Circle on Picture)
• • •
|
Billable Time
|
|
Ice (Circle Ice / Square Pic)
• • •
|
Billable Time
|
|
Hot Pk (Circle Hot / Square Pic)
• • •
|
Billable Time
|
|
KT (Lines w/ Label on Pic)
• • •
|
Billable Time
|
|
Therapy Pic
|
|
|
Orthotics
|
Notes for P - (FS)
|
|
Treatment Plan
|
|
|
Treatment Plan Date
|
Typical Goals/Plan
|
|
Custom Plan
|
***Tx Plan/Next Visit
• • •
|
|
* ST Goals - NO PAIN
|
* LT Goals - NO PAIN
|
|
* Anticipated Release
|
Treatment Frequency
|
|
Progress/Prognosis Follow Up
• • •
|
Records/Imaging Reviewed & Info
|
|
* Assess Thoughts on Case (FS)
|
Post Tx results
• • •
|
|
Radiology Order
• • •
|
Patient Education
• • •
|
|
Referral
• • •
|
Imaging Findings
|
|
**Treatment Provided
• • •
|
Face to Face Time
|
|
See Rehab Protocol
|
|
