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OpNote: Facet Joint | Facet Medial Branch Block Injection
ENTER OpNote Macro then "Injectate LOT/Exp" Macro here OR 'click' options below:
Lumbar Facet Joint Injection
with TPI (Lumbar Facet)
with SI Joint
PREOPERATIVE DIAGNOSIS
TPI Field
PreOp
POSTOPERATIVE DIAGNOSIS
TPI Field
PostOp
PROCEDURE
TPI Field
Procedure
MAC [Yes] / Local [No]
PreMed / Anxiolytic
INDICATION
TPI Field
Indication
OPERATIVE PROCEDURE
Prep
Facet Joint Location
• • •
Spinal Needle Size
Anesthetic %
Steroid Total (10 mg / joint)
Procedure Comments
SIJ Prep
SI Joint Location
Lumbar Medial Branch Block
with SI Joint / TPI
PREOPERATIVE DIAGNOSIS
PreOp
POSTOPERATIVE DIAGNOSIS
PostOp
PROCEDURE
Procedure
MAC [Yes] / Local [No]
PreMed / Anxiolytic
INDICATION
• • •
OPERATIVE PROCEDURE
Prep
Facet Joint Location
• • •
Spinal Needle Size
Target are L1 though L5 or L5-S1
• • •
Procedure Comments
SIJ Prep
SI Joint Location
Procedure Comments
Local Anesthetic
Cervical Facet Joint Injection
with TPI (Cervical Facet)
PREOPERATIVE DIAGNOSIS
TPI Field
POSTOPERATIVE DIAGNOSIS
TPI Field
PROCEDURE
TPI Field
MAC [Yes] / Local [No]
PreMed / Anxiolytic
INDICATION
TPI Field
OPERATIVE PROCEDURE
Prep
Facet Joint Location
• • •
Steroid
Anesthetic
Procedure Comments
Cervical Medial Branch Block
PREOPERATIVE DIAGNOSIS
PREOP DX
POSTOPERATIVE DIAGNOSIS
POSTOP DX
PROCEDURE
PROCEDURE
MAC [Yes] / Local [No]
PreMed / Anxiolytic
INDICATION
• • •
OPERATIVE PROCEDURE
Prep
Nerve Level Location
• • •
Procedure Comments
Thoracic Facet Joint Injection
with TPI (Thoracic Facet)
PREOPERATIVE DIAGNOSIS
TPI Field
POSTOPERATIVE DIAGNOSIS
TPI Field
PROCEDURE
TPI Field
MAC [Yes] / Local [No]
PreMed / Anxiolytic
INDICATION
TPI Field
OPERATIVE PROCEDURE
Prep
Facet Joint Location
• • •
Procedure Comments
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
Tolerated well? Yes / No
Tolerated Procedure Free Write
Recovery / Discharge
Recovery / Discharge Free Write
Injectate Product Information
Fluoroscopy Image #1
Fluoroscopy Image #2
Fluoroscopy Image #3
Fluoroscopy Image #4
Fluoroscopy Image #5

360 SOAP Objective Medical Form

Pain Management Specialist

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Published: Jan. 22, 2022, 4:48 p.m.
Doctor: Dr. History Physical
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Sunnyvale, CA 94089

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