|
PO/6wk
|
DVT Check Only
|
|
Referral Out
|
Photos today?
|
|
|
|
|
No DVT Bilateral
|
+DVT/SVT Findings from Exam
|
|
|
|
|
F/U with Treatment
• • •
|
F/U Free text
|
|
Follow up Timeline
|
F/U Timeline Free text
|
|
No Charge Ultrasound
|
|
|
Outbound Referrals
|
Houston Referrals
|
|
Lymphedema/Tactile Houston
|
Lymphedema Location
|
|
Patient has worn compression socks? (Houston)
|
Compression sock start date
|
|
Arterial Referral Houston
|
Arterial Referral Location
|
|
Wound Care Houston
|
Woundcare Referral Location
|
|
Podiatry Referral Houston
|
Podiatry Referral Location
|
|
Deep Venous Referral Houston
|
Deep Venous Referral Location
|
|
Pain & Rehab Houston
|
Pain and Rehab Referral Location
|
|
Free Text Houston
|
Notes for Procedure Scheduling (Houston)
|
|
Lymphedema/Tactile
|
Lymphedema Location
|
|
Lymphedema/BioTAB Healthcare
|
Lymphedema Location
|
|
Patient has worn compression socks?
|
Compression sock start date
|
|
Connie Cares non profit lymphedema (>4weeks compression)
|
|
|
Patient has worn compression socks?
|
Compression sock start date
|
|
Arterial Referral
|
Arterial Referral Location
|
|
Wound Care
|
Woundcare Referral Location
|
|
Podiatry Referral
|
Podiatry Referral Location
|
|
Deep Venous Referral
|
Deep Venous Referral Location
|
|
Pain & Rehab
|
Pain and Rehab Referral Location
|
|
Orthopedic
|
Orthopedic Referral
|
|
Lipedema
|
Lipedema Referral
|
|
Free Text
|
Notes for Procedure Scheduling
|
|
Clearance required for Vein treatments?
|
|
|
Exam Photos
|
|
|
Right Leg
|
|
|
Right lateral above knee
|
|
|
Right medial above knee
|
|
|
Right Lateral below knee
|
|
|
Right medial below knee
|
|
|
Right Ulcer/Important/Other
|
Right Ulcer/Important/Other
|
|
Right Ulcer/Important/Other
|
Additional Right leg comments
|
|
Left Leg
|
|
|
Left lateral above knee
|
|
|
Left medial above knee
|
|
|
Left lateral below knee
|
|
|
Left medial below knee
|
|
|
Left Ulcer/Important/Other
|
Left Ulcer/Important/Other
|
|
Left Ulcer/Important/Other
|
Additional Left Leg Comments
|
