|
Left Pulse
• • •
|
Right Pulse
• • •
|
|
Left pulse comments
|
Right pulse comments
|
|
Tongue
• • •
|
Visual Inspection
• • •
|
|
Phys Findings 1
• • •
|
Location 1
• • •
|
|
Phys Findings 2
• • •
|
Location 2
• • •
|
|
Phys Findings 3
• • •
|
Location 3
• • •
|
|
Abd Phys Findings 1
• • •
|
Abdominal Location 1
• • •
|
|
Abd Phys Findings 2
• • •
|
Abdominal Location 2
• • •
|
|
Provocative Test 1
|
Provocative Test 2
|
|
Provocative Test 3
|
Provocative Test 4
|
|
Beh Observ
• • •
|
Facial Observation
• • •
|
|
LMT today?
|
Herbs prescribed today
|
|
CPT #1
|
Start & End Time
/
|
|
Point Combinations
• • •
|
Motor Points
• • •
|
|
Gua Sha Location
• • •
|
Cupping
• • •
|
|
Tui Na
• • •
|
Bilaterally
|
|
Left
|
Right
|
|
97813
/
|
97813
/
|
|
97813
/
|
97813
/
|
|
Comments
|
E/M time (min), excludes tx
|
|
|
|
|
CPT #2
|
Start & End Time
/
|
|
Point Combinations
• • •
|
Motor Points
• • •
|
|
Bilaterally
|
Left
|
|
Right
|
Comments
|
|
97814
/
|
97814
/
|
|
97814
/
|
97814
/
|
|
Gua Sha Location
• • •
|
Cupping
• • •
|
|
Tui Na
• • •
|
|
|
CPT #3
|
Start & End Time
/
|
|
Point Combinations
• • •
|
Motor Points
• • •
|
|
Bilaterally
|
Left
|
|
Right
|
Comments
|
|
97814
/
|
97814
/
|
|
97814
/
|
97814
/
|
|
Gua Sha Location
• • •
|
Cupping
• • •
|
|
Tui Na
• • •
|
|
|
CPT #4
|
Start and End Time
/
|
|
Point Combinations
• • •
|
Motor Points
• • •
|
|
Bilaterally
|
Left
|
|
Right
|
Comments
|
|
97814
/
|
97814
/
|
|
Gua Sha Location
• • •
|
Cupping
• • •
|
|
Tui Na
• • •
|
|
|
CPT #5
|
|
|
CPT #5
|
Start & End Time
/
|
|
Tui Na
• • •
|
Cupping
• • •
|
|
Gua Sha Location
• • •
|
Comments
|
|
NAET
|
NAET Last Item Treated
|
|
NAET Last Item Clear?
|
NAET Emotion
|
|
NAET
|
NAET Other Items
|
|
Acup units
|
TDP lamp location
• • •
|
|
Tuning forks location
|
Moxa
|
|
Facial Rejuvenation Acupuncture
• • •
|
Sho Ni Shin
|
|
Aroma Acupoint Therapy
• • •
|
Aroma Acupoint Therapy™ Addl
|
|
Esoteric Acupuncture
• • •
|
|
|
Essential Oils
|
Essential Oil(s) A-C
• • •
|
|
Essential Oil(s) D-G
• • •
|
Essential Oil(s) H-L
• • •
|
|
Essential Oil(s) M-P
• • •
|
Essential Oil(s)R-Z
• • •
|
|
Acupuncturist
|
|
|
Post treatment status
|
Post treatment pain #
|
|
Post treatment comments
|
|
