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Acupuncture Consent Form
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Subjective
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Chief Complaint
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Objective
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Examination Findings
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Assessment
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Assessment
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Plan
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PLAN | TREATMENT PROCEDURES
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New Patient | w/o Estim, w/Infrared
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New Patient | w/o Estim, w/Infrared
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w/Estim, w/Infrared, w/Cupping
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w/ Estim, w/Infrared
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w/o Estim, w/Infrared, w/Cupping
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w/o Estim, w/Infrared
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Diagnosis Codes
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Neck pain
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Headaches
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Mid Back Pain
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Low back pain
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Left Shoulder Pain
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Right Shoulder Pain
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Left Knee Pain
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Right Knee Pain
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Left Ankle/Foot Pain
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Right Ankle/Foot Pain
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