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CC
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HPI
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Plan & CEAP Classification
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Detailed Treatment Plan Macro
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Treatments Needed (Click all that apply)
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Right GSV thigh
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Left GSV thigh
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Right GSV Below
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Left GSV Below
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Rt GSV Below Sclero
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Lt GSV Below Sclero
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Right SSV
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Left SSV
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Right AASV
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Left AASV
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Right PASV
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Left PASV
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Right Perforator
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Left Perforator
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Right Perforator 2nd
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Left Perforator 2nd
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Right Calf and Thigh (Varithena, trib/acc)
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How many?
• • •
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Left Calf and Thigh (Varithena, trib/acc)
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How many?
• • •
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Right Calf and Thigh Sclero (trib/acc)
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How Many?
• • •
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Left Calf and Thigh Sclero (trib/acc)
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How Many?
• • •
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Sclerotherapy (Right) (VV)
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How many?
• • •
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Sclerotherapy (Left) (VV)
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How many?
• • •
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Microphlebectomy (Right)
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How many?
• • •
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Microphlebectomy (Left)
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How many?
• • •
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Additional Procedure
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