|
Medical Decision Making
|
Plan Discussion
|
|
Opioid Compliance
|
Education
|
|
Medication prescribe
• • •
|
Medication prescribed comments
|
|
Home Exercise Program
|
completed HEP
|
|
completed PT
|
completed Chiropractic
|
|
Smoking Cessation counselling
|
|
|
ORDERS
|
|
|
Orders for todays visit
• • •
|
Follow up appointment
• • •
|
|
Follow up appointment comments
|
|
|
UDX
|
UDX
• • •
|
|
Medical Records
|
Medical Records
|
|
Clearance to hold anti-coag
|
Medical Clearance
|
|
Discharge: Practice
|
Discharge: Opioid program
|
|
REFERRALS
|
|
|
Referrals:
• • •
|
Referral Reason
|
|
RADIOLOGY ORDERS
|
|
|
Xray Orders
• • •
|
MRI/CT orders
• • •
|
|
OR PROCEDURE ORDER
|
|
|
Initial LESI Orders
• • •
|
Followup LESI orders
• • •
|
|
Initial CESI Orders
• • •
|
Follow up CESI orders
• • •
|
|
Initial TESI Orders
• • •
|
Follow up TESI Orders
• • •
|
|
LMBB
• • •
|
Lumbar RF
• • •
|
|
CMBB
• • •
|
Cervical RF
• • •
|
|
TMBB
• • •
|
Thoracic RF
• • •
|
|
TFESI Orders:
• • •
|
Sacroiliac joint injetion
• • •
|
|
Sympathetic Nerve Blocks
|
Hip Joint Injection Orders
• • •
|
|
Diagnostic Genicular Nerve block
• • •
|
Genicular Nerve Radiofrequency ablation
• • •
|
|
Piriformis Block
|
|
|
OFFICE BASED PROCEDURE ORDERS
|
|
|
Schedule Office Procedure
• • •
|
Office Procedure Comments
|
|
BRACE/TENS/TM FLOW/WAVI ORDERS
|
|
|
Lumbar Brace Order
|
Lumbar Brace dispense
|
|
Cervical Brace Order
|
Cervical Brace Dispense
|
|
Knee Brace Order
|
Knee Brace Dispense
|
|
TENS Unit Order
|
TENS Unit Dispensed
|
|
TM Flow
• • •
|
WAVI ORDERS
• • •
|
