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TRT
TRT with Gonadorelin
• • •
TRT without Gonadorelin
• • •
TRT with Clomid
• • •
Clomid
• • •
Gonadorelin without TRT
• • •
Start TRT at a Later Date
• • •
Levels Therapeutic
• • •
Trying to Conceive. TRT not approved.
• • •
Needing Medical Clearance to Start TRT
• • •
Elevated Hemoglobin cannot start TRT
• • •
Elevated Blood Pressure cannot start TRT
• • •
Additional Notes
Pricing
• • •
TRT Dose
TRT DOSE
• • •
Dosing TRT
Gonadorelin Dose
Gonadorelin Dose
• • •
Clomid dose
• • •
Clomid Dose
Anastrozole Dose
Anastrozole dose
• • •
Anastrozole Dose
Letrozole dose
• • •
Letrozole Dose
Follow up labs
Lab Follow. No Dose Change
• • •
Additional Notes
Lab Follow. Increase Dose
• • •
Additional Notes
Lab Follow. Decrease Dose.
• • •
Additional Notes
Lab Follow 8 week Pellet Placement
• • •
Additional Notes
Lab Follow. H/H Elevated. Dose not held.
• • •
Additional Notes
Lab Follow. Comp labs No Follow up Needed
• • •
Additional Notes
Lab Follow. Comp labs. Follow up Needed
• • •
Additional Notes
Lab Follow. Estradiol labs.
• • •
Additional Notes
Lab Follow. Critical Values
• • •
Additional Notes
Lab Follow up in house packs abnormal.
• • •
Additional Notes
Lab Follow up Cholesterol Panel
• • •
Additional Notes
Lab Follow up Thyroid
• • •
Additional Notes
Lab Follow Prolactin
• • •
Additional Notes
Lab Follow up Vitamin Panel
• • •
Additional Notes
Lab Follow up DHT/DHEA
• • •
Additional Notes
Telehealth lab Order
• • •
Additional Notes
Abnormal labs Discussed with Medical Director
• • •
Additional Notes
Current TRT Dose
• • •
Change TRT Dose
• • •
Last dose of Testosterone
• • •
Clomid dosing
• • •
Gonadorelin Dose
• • •
Gonadorelin Dose Change
• • •
DIM dose
• • •
Anastrozole dose
• • •
Anastrozole dose change
• • •
Letrozole dose
• • •
ASCVD RISK
• • •
Erectile Dysfunction Services
Treatments offered
• • •
Enhancement Packages
• • •
Mild ED Packages
• • •
Moderate ED Packages
• • •
Severe ED Packages
• • •
ED Medication Packages
• • •
Trimix medication with pricing
• • •
Oral dosing with Price for Viagra/Cialis
• • •
Refill Viagra/Cialis Oral Troche
• • •
Trial Tri-mix injection
• • •
Tri-mix dosing
• • •
PT141
• • •
Special pricing
GW Session with MA or Provider
GW Session with MA or Provider Focused Machine
• • •
GW Session with MA or Provider Radial Machine
• • •
Pellet Placement/Incision check
Pellet Placement
• • •
Total Number of Pellets with Lot Number and Expiration
Lido with Epi injection
• • •
Testosterone bolus SQ
• • •
Toradol bolus SQ
• • •
Vitamins Bolus SQ
• • •
Rocephin Bolus SQ given
• • •
Trocar number used for Procedure
• • •
Gonadorelin Dose
• • •
Anastrozole dose
• • •
Letrozole dose
• • •
Incision check
• • •
Peptides
Sermorelin
• • •
FAT BURNER BLEND AOD9604 | MOTS-c | TESMORELIN
• • •
BPC157
• • •
PERFORMACE BLEND CJC- 1295 |IPAMORELIN
• • •
Kisspeptin
• • •
BPC157/TB500
• • •
LL37/Thymosin Alpha 1
• • •
PT141
• • •
Thymosin Alpha 1
• • •
Peptide Issues
• • •
Pricing
• • •
PRP
PRP Initial Consult
• • •
Enhancement Packages
• • •
PRP Procedure
• • •
Semaglutide/Tirzepatide/Phentermine Plan
Semaglutide/Tirzepatide Plan
• • •
Dosing
• • •
Additional Notes
Phentermine Plan
• • •
Pricing
• • •
Vitamin Plan
Vitamin Plan
• • •
Vitamin Vial/Injection given
• • •
Vitamin Pricing
• • •
TRT Issues
Blood Pressure Problems
Elevated Blood Pressure Issues
• • •
Care Terminated for TRT Plan
Care Terminated
• • •
Dose Change
Dose Change
• • •
Elevated Hemoglobin
Elevated H/H Dose Held
• • •
Elevated H/H Dose not held
• • •
Elevated PSA marker
Elevated PSA Marker
• • •
Pt referred to Urology
PSA Result Prior and Current
Additional Notes
Hair loss
Hair loss
• • •
Injection Site Change
Injection site change
• • •
Plan Pain
Pain
• • •
Skin Infection
Plan Skin Infection
• • •
Testicle Atrophy
Testicle Atrophy
• • •
Additional Services
Botox
New Multiple Select
• • •
Microneedling plan
Microneedling Plan
• • •
Additional Notes
NeoGraft Consult or Procedure
Plan Consult/Procedure
• • •
NeoGraft Pricing/Total Grafts being Placed
NeoGraft Follow up
• • •

H&P Plan Medical Form

Nurse Practitioner

Rrespress8/27/24

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Published: Aug. 27, 2024, 11:12 a.m.
Doctor: Dr. History Physical
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