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PROCEDURE NOTE:
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PROCEDURE PREPARATIONS:
• • •
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Procedure Site:
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MEDICATION ADMINISTERED:
• • •
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NERVE BLOCK
• • •
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ADDITIONAL NERVE BLOCK INFO:
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NERVE BLOCK PROVIDED TO
• • •
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POSITION FOR PROCEDURE:
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TENDON INJECTION
• • •
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ADDITIONAL TENDON INJ. INFO:
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JOINT INJECTION
• • •
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JOINT INJECTION COMMENTS:
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TRIGGER POINT:
• • •
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TRIGGER POINT COMMENTS:
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HYALURONIC ACID INJECTION:
• • •
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Patient toleration to treatment:
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COMPLICATIONS:
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Improvement in Other Measures
• • •
|
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POST TREATMENT ASSESSMENT:
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Education and Expectations:
• • •
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ELECTRONICALLY SIGNED
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