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Prognosis
• • •
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Future Care As Needed? (*DC Only)
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Additional information
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Goals: (content)
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Goals (achievement timeline): weeks / months
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Goals (stabilizing timeline): weeks / months
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Next Encounter
• • •
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Treatment Outline
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Treatment plan notes
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Soft Tissue Treatment
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Chiropractic Adjustment
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Therapeutic Exercises
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Acupuncture Treatment
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Treatment Notes
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Restrictions
• • •
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Restriction notes
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Future Appointments (Core Plan): how many
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Week 1
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Week 2
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Week 3
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Week 4
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Week 5
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Week 6
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Week 7
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Week 8
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Week 9
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Week 10
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Week 11
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Week 12
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Week 13
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Week 14
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Week 15
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Week 16
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Low frequency follow-up visits: how many
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weeks to months out
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for how many weeks/months?
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or for how many times
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weeks to months out
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for how many weeks/months?
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or for how many times
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weeks to months out
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for how many weeks/months?
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or for how many times
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weeks to months out
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for how many weeks/months?
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or for how many times
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future appointments
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Exercise Program
• • •
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Referrals
• • •
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Notes
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