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Day 2 and TRT Transfer Selected for Transfer Patients
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Bloodwork Req for Hormone and GLP-1 PTS
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Clinical Plan
|
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Day 1 Hormone Therapy
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Day 1 Male Plan
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Day 1 Female Plan
|
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Day 2 Hormone Therapy
|
Transfer TRT Patient
|
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Day 2 Male Plan
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Day 2 Female Plan
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Transfer TRT Qualifies
|
Transfer TRT NO Qualify
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Additional Services
|
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Weight Loss
|
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New Patient
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GLP-1
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Non-GLP-1
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Existing Patient
|
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Existing New Patient GLP-1
|
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Existing Patient New Non-GLP-1
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Vitamin Therapy
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New Patient
|
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Vitamin Injection
|
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Vitamin Infusion
|
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Existing Patient
|
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Existing Patient New Vitamin Injection
|
|
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Existing Patient New IV
|
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Aesthetics
|
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PRP Facial
|
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PRP Scalp
|
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Day 1 Follow Up Plan
|
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Male Day 1 Qualifies
|
Male Day 1 Not Qualify
|
|
Female Day 1 Qualifies
|
Female Day 1 Not Qualify
|
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Transfer Patients: Complete Lab Form with Historic Lab Results
|
|
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Complete the *Day 1/ Day 2 Initial Results* Additional Form Note and document patient results.
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|
|
|
|
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Reschedule for Day 2 Testing
|
|
|
Day 1 that do not qualify, send SHBG to TestoThera Laboratory
|
|
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SHBG Sent To TestoThera Lab
|
|
|
Day 2 Plan
|
|
|
Male Day 2 Qualifies
|
Male Day 2 Not Qualify
|
|
Female Day 2 Qualifies
|
Female Day 2 Not Qualify
|
|
If SHBG Drawn and does not qualify, reschedule for T testing in 7 days.
|
|
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Patient Education
|
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TRT Contraindications Discussed With Patient
|
|
|
GLP-1 Contraindications Discussed
|
Non-GLP-1 Contraindications Discussed
|
|
Day 2 No Contraindications
|
Day 2 Contraindications Found
|
|
Contraindications Discovered
• • •
|
Other Contraindications Found
|
|
Vitamin Injection Education
|
|
|
PSA Scoring
|
Patient PSA Score Chart Score
|
|
PSA Score Normal
|
PSA Score Abnormal
|
|
Medication Administered
|
|
|
GLP-1 Medication Initiated
|
Non GLP-1 Medication Initiated
|
|
GLP-1 Medication Initiated
|
Non-GLP-1 Medication Initiated Today
|
|
Initial Testosterone Medication Administered Today?
|
|
|
Testosterone Cypionate Dose (mg)
|
Administration Location
• • •
|
|
|
Administrator Initials
• • •
|
|
Additional Services
|
|
|
Vitamin Injections
|
Initiating Vitamin Therapy Injection With
• • •
|
|
Follow Up Appointment
|
|
|
Schedule Follow Up Appointment
|
Schedule Referral
|
|
Days to return for NOV
|
Appointment Reason
• • •
|
|
Referrals
|
Referral Comments
|
|
Provider Section
|
|
|
Ready To Lock
|
Provider Initials / Signature
|
