|
|
with TPI (Misc.)
|
|
PREOPERATIVE DIAGNOSIS
|
TPI Field
|
|
POSTOPERATIVE DIAGNOSIS
|
TPI Field
|
|
PROCEDURE
|
TPI Field
|
|
TIVA [Yes] / Local [No]
|
IV Sedation [Yes] / Local [No]
|
|
INDICATION
|
TPI Field
|
|
OPERATIVE PROCEDURE
|
|
|
Dictate Note
|
Procedure
• • •
|
|
Occipital Nerve Block
|
with TPI (Occipital Nerve Block)
|
|
PREOPERATIVE DIAGNOSIS
|
TPI Field
|
|
POSTOPERATIVE DIAGNOSIS
|
TPI Field
|
|
PROCEDURE
|
TPI Field
|
|
TIVA [Yes] / Local [No]
|
IV Sedation [Yes] / Local [No]
|
|
INDICATION
|
TPI Field
|
|
OPERATIVE PROCEDURE
|
|
|
Patient position
|
|
|
Location
|
|
|
Prep
|
|
|
Location
|
Freewrite
|
|
TRIGGER POINT INJECTION (TPI)
|
|
|
Cervical (Right / Left)
|
Cervical (B/L)
|
|
Cervical / Trapezius (Right / Left)
|
Cervical / Trapezius (B/L)
|
|
Trapezius (Right / Left)
|
Trapezius (B/L)
|
|
Thoracic (Right / Left)
|
Thoracic (B/L)
|
|
Lumbar (Right / Left)
|
Lumbar (B/L)
|
|
TPI Comments
|
|
|
Follow Up
• • •
|
|
|
Outcome / Follow up
• • •
|
|
|
Recovery Room Yes / No
|
|
|
Fluoroscopy / Ultrasound Image #1
|
|
|
Fluoroscopy / Ultrasound Image #2
|
|
|
Fluoroscopy / Ultrasound Image #3
|
|
|
Fluoroscopy / Ultrasound Image #4
|
|
