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Acupuncture History
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Chief complaint
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Second Complaint
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Basic Notes
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Five phases history
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Favorite color
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Flavor preference
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Pyschoemotional state
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Season preference
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Acupuncture symptom review
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1. Fever & Chills
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2. Sweats
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3. Bowel Movement
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4. Urination
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5. Appetite & Thirst
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6. Sleep
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7. Ears and Eyes
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8. Body temperature
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Pain
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Complaint #1
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Pain severity on Complaint #1
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Complaint #2
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Pain severity on Complaint #2
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New Complaint
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Pain severity on New Complaint
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Nature
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Timing
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Pressure
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Temperature
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Food & Drink
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Bowel Movement
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Movement & Rest
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Acupuncture exam
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Pulse
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Left Pulse
• • •
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Right Pulse
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Tongue
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Tongue Body Color
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Tongue Body Shape
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Tongue Coating
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Point palpation
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Meridian tender points
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Acupoint prescription
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Point Combinations
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Notes
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Extra Points
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Notes
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windows of the sky
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Cerebral circulation pathways
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Notes
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Notes
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KB1 (inerosseous b/w ulna and radius
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KB2 (interosseous bw tibia/fibula)
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Surface release techniques
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scar deactivation
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Acupuncture Documentation:
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Acupuncture Note:
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Acupuncture Front of Body
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Acupuncture Back of Body
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Auricular Chart
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Meridian Face
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knee periosteal
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hip periosteal
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shoulder periosteal
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Elbow periosteal
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Wrist periosteal
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Ankle periosteal
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Deep foot/ba feng
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KD
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HT
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BL
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SI
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LR
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MOH
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GB
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TH
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SP
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LU
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ST
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LI
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Governing Vessel
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Conception Vessel
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Notes
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Notes
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Details
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Dx
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Tx
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