ChiroCredit.com / OnlineCE.com presents Documentation 101 Part 3 of 10 Instructor: Paul Sherman, DC
|
|
- Geoffrey Peters
- 5 years ago
- Views:
Transcription
1 Online Continuing Education Courses ChiroCredit.com / OnlineCE.com presents Documentation 101 Part 3 of 10 Instructor: Paul Sherman, DC Important Notice: This download is for your personal use only and is protected by applicable copyright laws. Its use is governed by our Terms of Service on our website (click on Policies on our website s side navigation bar). OBJECTIVE PORTION OF THE PROGRESS NOTES SHOULD BE DOCUMENTED USING THE P.A.R.T SYSTEM: P.A.R.T. system consists of the following: P-Pain/tenderness: Evaluated in terms of location, quality and intensity. This can be identified through observation, percussion, palpation, provocation, etc. In addition, pain intensity may be assessed using one or more of the following i.e.: visual analog scale, algometers, pain questionnaires, etc. A-Asymmetry/misalignment: Evaluated on a sectional or segmental level through static palpation, diagnostic imaging and observation i.e.: (posture and gait analysis). R-Range of motion abnormality: Evaluated in changes of active, passive and accessory joint movements which may result in an increase or a decrease in sectional or segmental mobility. In addition, ROM abnormalities may be identified by one or more of the following i.e.: motion palpation, observation, stress diagnostic imaging, range of motion measurements, etc. T-Tissue, tone, texture or temperature abnormality: Evaluated by changes in the characteristics of contiguous or associated soft tissues which include skin fascia, muscle and ligaments. This may be identified by one or more of the following i.e.: observation, palpation, use of instrumentation, etc. Note: To document a subluxation based on physical examination the doctor must meet two of the four criteria of the P.A.R.T. system, one of which must be asymmetry/misalignment or range of motion abnormality. MEDICARE DOCUMENTATION REQUIREMENTS FOR INITIAL VISIT AND SUBSEQUENT VISITS: MEDICARE DOCUMENTATION REQUIREMENTS FOR INITIAL VISIT: 1
2 1. Patient history, which should include the following: Symptoms causing the patient to seek treatment (Chief Complaint) Onset, duration, intensity, frequency, location and radiation of symptoms Quality and character of symptoms/problems Aggravating and/or relieving factors Mechanism of trauma Family history if relevant Past health history (general health, prior illnesses, injuries, surgery, hospitalizations and medications) Prior interventions, treatments, medications, secondary complaints 2. Description of present illness, which should include the following: Patient s symptoms must bear a direct relationship to the level of subluxation. The symptoms should refer to the spine, muscle, bone, rib and joint and be reported as swelling, spasm, etc. Vertebral pinching of spinal nerves may cause headaches, arm, shoulder and hand problems as well as leg and foot pains and numbness. Rib and rib/chest pains are also recognized symptoms, but in general other symptoms must relate to the spine. The subluxation must be causal (the symptoms must be related to the level of the subluxation that has been idenitifed). The location of pain must be described and whether the particular vertebra listed is capable of producing pain in the area determined. 3. Evaluation of the NMS system through physical examination. 4. Diagnosis, which should include the following: The primary diagnosis must be subluxation, including the level. Such terms may refer either to the condition of the spinal joint involved or to the direction of position assumed by the particular bone named. 5. Treatment Plan, which should include the following: Recommended level of care (duration and frequency of visits) Note: Important to reference visit number based upon duration of the care plan for the episode of care being provided i.e.: visit 1 of 12, visit 2 of 12, visit 3 of 12, etc. Specific treatment goals Note: Should have a starting point and time frame for trying to meet the goals. Quantifying and measuring goals is also important. Objective measures to evaluate treatment effectiveness i.e.: standardized pain and functional assessment tools should be used. 6. Date of the initial treatment. 2
3 MEDICARE DOCUMENTATION REQUIRED FOR SUBSEQUENT VISITS REGARDLESS IF THE SUBLUXATION IS DEMONSTRATED BY AN X-RAY OR BY PHYSICAL EXAMINATION: 1. History, which should include the following: Review of chief complaint Changes since last visit System review, if relevant 2. Physical Exam, which should include the following: Exam of area involved in diagnosis Assessment of how the patient s condition changed since last visit Evaluation of treatment effectiveness 3. Documentation of treatment given on day of visit. MEDICAL DOCUMENTATION (PROGRESS NOTES) AFTER INITIAL VISIT (SUBSEQUENT VISITS) SHOULD ALWAYS BE PERFORMED IN THE S.O.A.P. FORMAT: 1. S-Subjective complaint, which should include the following: Document how the patient is feeling. This should include location of pain, quantity and quality of pain, level of function (ADL) and severity of pain (qualify by using pain analog scale 0-10, (0-no pain, 10-severe pain). In addition, outcome assessment questionnaires should be utilized to further document care. Differentiate Quantity vs. Quality of Pain: Quantity: (Amount of time patient feels pain per day) Descriptors of Pain Quantity: Occasional Feels pain up to 25 % per day Intermittent Feels pain up to 50% per day Frequent Feels pain up to 75% per day Constant Feels pain all day 100% Infrequent Not daily Quality: (How pain affects patient s function/adl) Descriptors of Pain Quality: Minimal Pain During ADL patient forgets pain Minor (Slight) Pain Pain doesn t prevent patient from doing ADL if they briefly pause or change 3
4 positions i.e.: sitting, lifting, carrying, pushing, pulling, dancing, housework, yard work, playing golf, working on computer, etc Moderate (Significant) Pain Patient is able to perform ADL, but pain forces them to rest Severe Pain Pain precludes patient from doing anything Determining Severity of Pain: Use OAT s (outcome assessment tools) Begin at start of care to determine an initial baseline Use during follow-up/re-examinations Use during exacerbations Use at end of care/discharge of patient Always calculate outcome scores and compare results of outcomes Important Tools Utilized for Outcome-Based Care: Pain (QVAS)-Quadruple visual analog scale and pain drawings to assess pain level Disability/Function (Bournemouth questionnaires, Neck Pain Disability Index, Oswestry Low Back Pain Scale & (PSFS)-Patient specific functional pain scale all to assess impact on ADL (quantity & quality of pain) Patient s Global Impression of Change-PGIC (assesses patient satisfaction and provides an ongoing evaluation of perceived progress with treatment) Benefits to Becoming Outcome-Based: Enhances quality care for patients Helps protect against liability Improves reimbursement Provides better evidence for care 2. O-Objective findings, which should include the following: Document visual observation (inspection), physical examination findings i.e.: static and motion palpation which includes muscle spasm/tightness, tenderness, trigger points and ROM. Document orthopedic and neurological testing, laboratory studies and diagnostic imaging i.e.: X-ray findings, MRI, CT-scan, Bone scan etc. Document objective portion of SOAP notes as per the P.A.R.T. system previously discussed). In addition, physical performance tests fall under this category (see below for some examples of physical performance tests). Examples of Physical Performance Tests: Repetitive squat Repetitive sit-up Static back or neck endurance One leg stand Horizontal side bridge endurance 4
5 Grip test Purpose of Physical Performance Tests: Measures function not pain Helps motivate patients to perform exercises and adhere to better compliance Goal is to transition patient from pain relief to functional restoration Note: Performed post acute pain phase 3. A-Assessment, which should include the following: Diagnostic impressions, short and long term goals and expected functional outcomes. In addition, the doctor should evaluate the overall progress the patient is making to their treatment plan i.e.; patient better, worse or the same. Short Term Goals: Decrease muscle spasm Reduce inflammation Alleviate pain Maintain ADL Return patient to work Long Term Goals: Increase normal physiological movements of the joints (ROM) Restore strength and/or endurance Increase flexibility Increase physical work capacity Return patient to full work capacity Modify social and recreational activity (life style changes) 4. P-Plan, which should include the following: Document treatment received and frequency patient will be seen i.e.; 2 x wk for 4 wks with re-evaluation. Document what procedure was performed on the patient that day, exactly where on the body was the treatment rendered, what settings were used if P.T. was involved, how long was it done, what dosages and frequency were used. Anyone in the room or assisting in the treatment or exam should be listed. Indicate plans for future assessment i.e.: re-examination/re-evaluation, prognosis, and anticipated discharge, referral for consultations, examinations, treatment or follow-up diagnostic testing. Document any patient instructions i.e.: home care (ice/heat, belts/collars, exercises, work/home restrictions etc), medications or nutritional supplements recommended. You can indicate patient tolerated procedures well (PTPW) if in fact they did. If any complications do not ignore them, describe the problem and indicate what instructions were given to the patient to remedy the situation. In addition, a brief post assessment of that days treatment should be performed, which is intended to evaluate the patient s response to their treatment for that day. This post assessment is not considered a re-examination/re-evaluation of the patient. Note: Always date progress notes and be as specific as possible when documenting medical information as this is critical for good patient management and will be 5
6 beneficial if litigation is brought against you by the patient. Sign or initial SOAP notes when completed. Benefits of Appropriately Documenting SOAP Notes: Reduces doctor s risk of malpractice Helps document communication between doctor/patient relationship Assists in meeting NCQA guidelines Assists with associates and covering doctor s Helps to document care and improve patient management Protects doctor with regards to HIPAA Privacy Standards Enhances communication with insurance companies (third party payers) and other professionals Improves outcomes with PIP arbitration Reduces cut-offs from I.C.E/I.M.E doctor s Increases number of visits available for the patient Increases doctor s income 6
Medicare Regulations for Chiropractors. Presented by Clinic Pro Software Inc. Marilyn K. Gard. CEO, MBA
Medicare Regulations for Chiropractors Presented by Clinic Pro Software Inc. Marilyn K. Gard. CEO, MBA Use AT modifier which means active treatment. Claims submitted for Chiropractic manipulative treatment
More informationMedicare Protocols and Procedures By Dr. Ron Short, DC, MCS-P
Medicare Protocols and Procedures By Dr. Ron Short, DC, MCS-P Intake (Initial Visit) At the initial visit you need to gather specific information in the history that Medicare requires. You need to inform
More informationNOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by
NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services News Flash Looking for the latest Medicare Fee-For-Service (FFS) information? Then subscribe to a Medicare FFS Provider
More informationNOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by
NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden
More informationDocumentation for Chiropractic Evaluations (DeskBook Chapter 4.2)
Documentation for Chiropractic Evaluations (DeskBook Chapter 4.2) Presented by Evan M. Gwilliam, DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP Vice President 1 Dr. Evan Gwilliam Education Bachelor s of
More informationMeeting the Medicare Requirements With Mario Fucinari DC, CCSP, CPCO, MCS-P, MCS-I Sponsored by NCMIC
Meeting the Medicare Requirements With Mario Fucinari DC, CCSP, CPCO, MCS-P, MCS-I Sponsored by NCMIC The information contained in these notes is for educational purposes and is not intended to be and
More informationTOP RYDE CHIROPRACTIC
1. Ankle Pain Conditions Helped by Chiropractic The ankle joint is made up of ligaments, tendons, nerves, and a disc to cushion motion. Distortions of motion of the ankle can strain the ligaments and muscles
More informationTreatment Plan Goals for Chiropractic
Treatment Plan Goals for Chiropractic Presented by Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA Vice President 1 Take away Learn how payers use treatment plan goals to determine if
More informationWelcome to Compass Chiropractic!
Welcome to Compass Chiropractic! Name Age Birth Date / / Home Phone: Cell Phone: Preferred Number: Cell / Home Address: City: State: Zip: Occupation: Email Marital Status: M W D S P Spouse s Name: Number
More informationChiroCredit.com / OnlineCE.com presents Documentation 101 Part 4 of 10 Instructor: Paul Sherman, DC
Online Continuing Education Courses www.onlinece.com www.chirocredit.com ChiroCredit.com / OnlineCE.com presents Documentation 101 Part 4 of 10 Instructor: Paul Sherman, DC Important Notice: This download
More informationChiroCredit.com / OnlineCE.com presents Documentation 101 Part 5 of 10 Instructor: Paul Sherman, DC
Online Continuing Education Courses www.onlinece.com www.chirocredit.com ChiroCredit.com / OnlineCE.com presents Documentation 101 Part 5 of 10 Instructor: Paul Sherman, DC Important Notice: This download
More informationTREATMENT OF CHRONIC MECHANICAL NECK PAIN IN AN OUTPATIENT ORTHOPEDIC SETTING
TREATMENT OF CHRONIC MECHANICAL NECK PAIN IN AN OUTPATIENT ORTHOPEDIC SETTING Clinical Problem Solving II Allison Walsh PATIENT OVERVIEW Age: 22 years Gender: Female Chief Complaint: Cervical pain, cervicogenic
More informationMedicare Benefit Policy Manual
Medicare Benefit Policy Manual Chapter 15 Covered Medical and Other Health Services Table of Contents (Rev. 235, 07-11-17) Transmittals for Chapter 15 10 - Supplementary Medical Insurance (SMI) Provisions
More informationPhysical Evidence Chiropractic 7035 Beracasa Way, Suite 103 Boca Raton Florida, Phone# (561) Fax# (561)
7035 Beracasa Way, Suite 103 Boca Raton Florida, 33433 Phone# (561)674-1217 Fax# (561)361-4999 Date File # PERSONAL HISTORY Last Name First Name middle Address City State Zip Date of Birth Age Social Security
More informationName Date / / Age Male/ Female Address City State Zip
T 1 2 3 : Name _ Date / / Age Male/ Female Address City State Zip Phone: Home Cell Cell Phone Provider Email Address Date of Birth / / Occupation Employer Single / Married / Divorced / Widowed Spouse s
More informationDocumentation for Daily Treatment Visits (DeskBook Chapter 4.3)
Documentation for Daily Treatment Visits (DeskBook Chapter 4.3) Presented by Evan M. Gwilliam, DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP Vice President 1 Dr. Evan Gwilliam Education Bachelor s of Science,
More informationMove Better, Feel Better: What Can Physical Therapy Do For You
Back to Basics Move Better, Feel Better: What Can Physical Therapy Do For You Dr. Stephen Baxter, Dr. Dean Yamanuha Department of Physical Therapy and Rehabilitative Sciences 5/16/2017 Dr. Stephen Baxter
More informationSpine Conditions and Treatments. Your Guide to Common
Your Guide to Common Spine Conditions and Treatments The spine is made up of your neck and backbone. It allows your body to bend and move freely. As you get older, it is normal to have aches and pains.
More informationWill you documentation meet Medicare s requirements? Nicholas R. Payne D.C.
Will you documentation meet Medicare s requirements? Nicholas R. Payne D.C. Understand what is covered by Medicare and the definition of Maintenance care. Understand the importance of the LCD and where
More informationLumbar Epidural Injections. Treatment to Reduce Pain
Lumbar Epidural Injections Treatment to Reduce Pain What Is a Lumbar Epidural Injection? Your doctor may have suggested you have a lumbar epidural injection. This procedure can help relieve low back and
More informationFCE JSA EJA. When is your patient safe to return to work? Introduction. The Industrial Rehabilitation System. Work Conditioning.
When is your patient safe to return to work? Introduction Presented by: Jonathan Reynolds, PhD, PT Bloswick, 2000 INJURY FCE JSA EJA Physician Chiropractor Physical Therapist Occ. Therapist CASE RESOLUTION
More informationChiropractic Glossary
Chiropractic Glossary Anatomy Articulation: A joint formed where two or more bones in the body meet. Your foot bone, for example, forms an articulation with your leg bone. You call that articulation an
More informationHome Address. City Postal Code Home Telephone # Business Telephone # Address. Emergency Contact Name, Address, Phone#
Date Name / / last first middle initial Personal Health # - Male Female Home Address City Postal Code Home Telephone # Business Telephone # Cell # E-Mail Address Best way to contact you: Home # Work #
More informationLIST YOUR HEALTH CONCERNS BELOW
8209 Natures Way Unit 115 Lakewood Ranch, Florida 34202 (941) 877.1507 Name Date / / Age Male Female Address City State Zip Phone: Home Cell Cell Phone Provider Email Date of Birth / / Employer s Name
More informationAdult New Patient Intake. Your Health Summary
Adult New Patient Intake Name Age Birth Date / / Soc. Sec. # - - Home Phone Cell Phone Address: City: State: Zip: Occupation: Email Marital Status: M W D S Spouse s Name: Children # and Ages: Whom may
More informationLIST YOUR HEALTH CONCERNS BELOW
T 1 2 3 ROOTS CHIROPRACTIC HEALTH PROFILE In Name Date / / Age Male/Female Address City State Zip Phone: Home Cell Work Email Address Date of Birth / / Occupation Employer's Name Single / Married / Divorced
More informationCERVICAL STRAIN AND SPRAIN (Whiplash)
CERVICAL STRAIN AND SPRAIN (Whiplash) Description time and using proper technique decrease the frequency of Whiplash is an injury to the neck caused when it is forcefully whipped or forced backward or
More informationNew Practice Member Paperwork
Cornerstone Family Chiropractic Health Information Form 928.237.9477 www.cfc4familyhealth.com 2225 E State Route 69 Suite A Prescott, AZ 86301 New Practice Member Paperwork This form is for adults only.
More informationCurrent Health Information
Name: : / / Current Health Information List your health concerns below: Health Concerns: (List according to severity) Rate of Severity 1 = Mild 10 = Unbear able When did the Symptom s Start? Are the Symptoms
More informationWho may we thank for referring you?
NEW PRACTICE MEMBER APPLICATION Name Date of Birth / / Age Male/Female Address City State Zip Phone: Cell Home Social Security #: Email: Occupation Employer s Name Status: Single / Married / Divorced /
More informationChiropractic Healthcare. What, How, & Why
Chiropractic Healthcare What, How, & Why Table of Contents Introduction 3 Topics Why Should Anyone go to a Chiropractor? 4 What to Expect on Your First Visit 7 Chiropractic and Exercise: Better than Drugs
More informationNew Practice Member Application
New Practice Member Application Name Date of Birth / / Age Male/Female Address City State Zip Phone: Cell Home Social Security #: Email: Occupation Employer s Name Status: Single / Married / Divorced /
More informationBrisbin Family Chiropractic
Information reviewed with patient: Dr. Initials Today s Date Brisbin Family Chiropractic Name: Sex: Male Female Address: City: Postal Code: Home Ph# Work# Ext# Cell# Preferred number (circle one) Home
More informationDoes Your Documentation Meet ICD-10 and Medicare Requirements?
Per the rules of the Florida Board of Chiropractic Medicine, each attendee is required to have his/her badge scanned 4 times a day with Photo ID at the attendance desk regardless of which classes you attend.
More informationChild (0-17) New Patient Intake Form. Child s Health Summary
Child (0-17) New Patient Intake Form Child s Name Age Birth Date / / Soc. Sec. # - - Parent/Guardian Name: Address: City: State: Zip: Parent/Guardian Email: Parent/Guardian Phone: Whom may we thank for
More informationWhy choose Ottauquechee PT
Why does your back hurt? Low back pain is one of the most common patient complaints affecting 80% of adults at some point in their lives. Generally the source of pain is in the spine and/or its supporting
More informationCERVICAL STRAIN AND SPRAIN
CERVICAL STRAIN AND SPRAIN Description Cervical strain/sprain is an injury to the neck caused when it is forcefully whipped or forced backward or forward. The structures involved are the muscles, ligaments,
More informationDate of Birth: Sex: O Male O Female Marital Status? O M O W O D O S. Chiropractic Care
Basic Information Full Name: Address: City: State: Zip: Cell: Home: Work: Date of Birth: Sex: O Male O Female Marital Status? O M O W O D O S Email: Occupation: Emergency Contact: Phone: Children: O No
More informationADIO CHIROPRACTIC HEALTH PROFILE
ADIO CHIROPRACTIC HEALTH PROFILE Name Date / / Age Male/Female Address City State Zip Phone: Home Cell_ Date of Birth / / Email Address For confirming appointments, would you prefer? EMAIL or TEXT CELL
More informationChild s Name Birth Date / / Age. Mother's Name. Father's Name. Phone: Home Cell. Address. Address Number & Street City State Zip
Welcome! Thank you for choosing our practice for your health needs. Your first visit to our center is an opportunity for us to learn all about you. If you have any questions or concerns, do not hesitate
More informationWelcome to Carefree Chiropractic! Please take your time completing the following information so we can serve you to the best of our ability.
Welcome to Carefree Chiropractic! Please take your time completing the following information so we can serve you to the best of our ability. Patient Information Title: Mr. Mrs. Miss Ms. Dr. (circle one)
More informationSpondylolisthesis DESCRIPTION EXPECTED OUTCOME POSSIBLE COMPLICATIONS COMMON SIGNS AND SYMPTOMS GENERAL TREATMENT CONSIDERATIONS CAUSES
DESCRIPTION is the slippage of one or more vertebrae, the bones of the spine. Many causes of slippage of the vertebra are possible; these include stress fracture (spondylolysis), which is often seen in
More informationBACK SPASM. Explanation. Causes. Symptoms
BACK SPASM Explanation A back spasm occurs when the muscles of the back involuntarily contract due to injury in the musculature of the back or inflammation in the structural spine region within the discs
More informationLIST YOUR HEALTH CONCERNS BELOW
Name Date / / Age Male/Female Address City State Zip Phone: Cell Cell Phone Provider Date of Birth / / Email Address Occupation Employer s Name Single/Married/Divorced/Widowed Spouse s Name Number of Children
More informationWelcome To Our Office
Welcome To Our Office Mission Statement Our office is dedicated to educating and adjusting as many families as possible towards optimal health through natural chiropractic care. We believe the greatest
More informationHEALTH RECORD REASON FOR THIS VISIT ABOUT YOU ABOUT YOUR SPOUSE HEALTH HABITS EXPERIENCE WITH CHIROPRACTIC
HEALTH RECORD ABOUT YOU REASON FOR THIS VISIT Name Address City State Zip _Home phone Birth date Cell Phone Age Gender Number of children Employer Work address Work phone Occupation Marital Status Social
More informationAPPLICATION FOR CARE AT LAUNCH CHIROPRACTIC
Whom may we thank for referring you to this office? APPLICATION FOR CARE AT LAUNCH CHIROPRACTIC Today s Date: HRN: PATIENT DEMOGRAPHICS Name: DOB: Age: Male Female Address: City: State: Zip: E-mail: Home
More informationSpineFAQs. Lumbar Spondylolisthesis
SpineFAQs Lumbar Spondylolisthesis Normally, the bones of the spine (the vertebrae) stand neatly stacked on top of one another. The ligaments and joints support the spine. Spondylolisthesis alters the
More informationName Date / / Age Male/Female Address City State Zip Phone: Home Cell Carrier (Ex: AT&T, Verizon)
Name_ Date / / Age Male/Female Address City State Zip Phone: Home Cell Carrier (Ex: AT&T, Verizon) For reminders do you prefer Phone Calls, Text Messages or Emails? CALL ME / TEXT ME / EMAIL ME Email Address
More informationHistory Prior to Presenting to Us
2013 Part 3 Cox Certification in Maui Case Report Moderate Adolescent Idiopathic Scoliosis (AIS) while being braced, now presents with lumbar disc disorder with sciatica, treated using Cox Technic Protocols.
More informationDr. Gary Malstrom B.Sc.(Hon.), D.C., C.Ac Brant Street, Burlington, Ontario L7R 2J9 (905) Fax (905)
Dr. Gary Malstrom B.Sc.(Hon.), D.C., C.Ac. Personal History: Name: Address: City: Province: Postal Code: Birth date: day /month /year Age: Sex: M F Home Phone: Business Phone: Cell Phone: E-mail: Health
More informationPERSONAL INJURY QUESTIONNAIRE
PERSONAL INJURY QUESTIONNAIRE Personal Information: Name: Home phone #: Address: Alt. phone #: City/State/Zip: Email address: Date of birth: Age: Social Security #: Insurance Information: (Vehicle You
More information7 Element Order. elsewhere classified, Spinal stenosis, lumbar region, without neurogenic claudication. Physician signature:
7 Element Order Medicare national and local policy specify that following completion of the face-to-face examination, the physician or treating practitioner must complete a written order containing seven
More informationLife can cause spinal stenosis. Take yours back with Superion.
Indirect Decompression System Life can cause spinal stenosis. Take yours back with Superion. Superion can help you take back your life with a simple new procedure. What is spinal stenosis? Your spine is
More informationPlease take the time to answer all questions that apply to your problem as completely as possible. Thank You.
USC Center for Spinal Surgery New Patient History Form Please take the time to answer all questions that apply to your problem as completely as possible. Thank You. Date Referring Doctor/Primary Doctor
More informationCox Technic Case Report #126 published at (sent December 2013 ) 1
Cox Technic Case Report #126 published at www.coxtechnic.com (sent December 2013 ) 1 Cox Technic Decompression Spinal Manipulation Resolves Symptoms Associated with Disc Protrusion and S1 Radiculopathy,
More informationPATIENT REGISTRATION FORM
PATIENT REGISTRATION FORM NAME: D.O.B AGE: SEX: STREET: CITY: STATE: ZIP: SS #: ETHNICITY: RACE: LANGUAGE: PHONE # TO LEAVE A PERSONAL MESSAGE: HOME PHONE #: WORK #: CELL #: E MAIL ADDRESS: EMERGENCY CONTACT:
More informationCIRCLE ALL CURRENT PROBLEMS YOU HAVE
INSIDE OUT CHIROPRACTIC HEALTH PROFILE Name Date / / Age Male/Female Address City State Zip Phone: Home Cell_ Date of Birth / / Email Address For confirming appts, would you prefer? TEXT (cell carrier:
More informationContractor Information. LCD Information. Local Coverage Determination (LCD): Chiropractic Services (L37387) Document Information
Local Coverage Determination (LCD): Chiropractic Services (L37387) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information Contractor
More information1
www.empireperformancept.com 1 Copyright Notice 2017 Empire Performance PT, LLC All rights reserved. Any unauthorized use, sharing, reproduction or distribution of these materials by any means, electronic,
More informationProving Medical Necessity, Functional Improvement, and Maintenance Care By Dr. Ron Short, DC, MCS-P, CPC, CPCO
Proving Medical Necessity, Functional Improvement, and Maintenance Care By Dr. Ron Short, DC, MCS-P, CPC, CPCO The Big Three Problems The three major complaints that Medicare has regarding chiropractic
More informationPersonal and Family Health History
Personal and Family Health History Date Name Social Security Address Occupation City State Zip Employer Phone: (H): (W): Marital Status: S M D W E-mail Spouse s Name Date of Birth Age Spouse s Occupation
More informationERI Safety Videos Videos for Safety Meetings. ERGONOMICS EMPLOYEE TRAINING: Preventing Musculoskeletal Disorders. Leader s Guide 2001, ERI PRODUCTIONS
ERI Safety Videos Videos for Safety Meetings 2120 ERGONOMICS EMPLOYEE TRAINING: Preventing Musculoskeletal Disorders Leader s Guide 2001, ERI PRODUCTIONS ERGONOMICS EMPLOYEE TRAINING: Preventing Musculoskeletal
More informationRevelation Chiropractic Health Profile
Revelation Chiropractic Health Profile Name Date / Age Male / Female Address Apt City Zip Phone Numbers: Home Cell Circle best number to reach you at: Home Cell Date of Birth / / Occupation Email Address
More informationWhat is a Chiropractic Treatment?
What is a Chiropractic Treatment? Have you ever been to the Chiropractor? Do you know exactly what to expect when you visit one? Well, here is a complete and thorough guide for you to understand exactly
More informationUnderstanding Back Pain
Understanding Back Pain Back pain affects the vast majority of Americans Back pain is second only to the common cold for the medical complaint doctors hear most often and for causing people to miss the
More informationFOR THE SERVICE MEMBER: Rx3 REHABILITATION PROGRAM
CREATED BY THE HUMAN PERFORMANCE RESOURCE CENTER / HPRC-ONLINE.ORG / FROM THE CONSORTIUM FOR HEALTH AND MILITARY PERFORMANCE HUMAN PERFORMANCE RESOURCE CENTER Injury/Condition: Injury/Condition: What is
More informationHistory Prior to Presenting to Us
2013 Part 3 Cox Certification in Maui Case Report Chronic Severe S Scoliosis (Lumbar dextroscoliosis and Thoracic levoscoliosis) treated successfully using Chiropractic for over 30 years and Cox Technic
More informationNeck Pain Guide. Understanding Causes, Treatment and Prevention
Neck Pain Guide Understanding Causes, Treatment and Prevention Neck pain may be more than a nuisance; it could be a symptom of an underlying condition. Use this guide to help you understand common causes
More informationAPPLICATION FOR CARE AT OPTIMAL HEALTH CHIROPRACTIC
Today s Date: APPLICATION FOR CARE AT OPTIMAL HEALTH CHIROPRACTIC PATIENT DEMOGRAPHICS Name: Birth Date: / / Age: Male Female Address: City: State: Zip: E-mail Address: Home Phone: Cell Phone: Martial
More informationSciatica. 43 Thames Street, St Albans, Christchurch 8013 Phone: (03) Website: philip-bayliss.com
43 Thames Street, St Albans, Christchurch 8013 Phone: (03) 356 1353. Website: philip-bayliss.com Sciatica Nagging, burning pain radiating down the back of the leg, or dull throbbing pain in the buttocks
More informationStep 1: The Physical Examination
7 Steps to Perfect Case Management The Rules of the Game Have Changed Protect Your Patients & Your Practice 7 Steps To Systematic Case Management 1. PE: Physical Examination Findings 2. FCE: Functional
More informationCHIROCENTER. Home Address: City: State: Zip: I would like to receive notifications Please do not send notifications
CHIROCENTER PATIENT ADMITTANCE Name: (First) (Middle Int). (Last) Today s : Home City: State: Zip: Telephone: Work: Cell: of Birth: Sex: M or F Social Security#: (Month) (Day) (Year) Circle if you are:
More informationFSBPT Supervised Clinical Practice Performance Evaluation Tool
1. Practices in a manner that is safe for the patient 1.1. Responds appropriately in emergency situations 1.2. Recognizes and responds to unexpected changes in patient's physiological condition 1.3. Utilizes
More informationChapter 2 Diagnostic Algorithms. 4 Traumatic Neck Pain Algorithm
Chapter 2 Diagnostic Algorithms 4 Traumatic Neck Pain Algorithm Patient presents with a traumatic onset of neck pain. In general, radiographs should be ordered with a history of recent, significant trauma.
More informationPATIENT ENTRANCE FORM
PATIENT ENTRANCE FORM Name _ Date Address City/ Province Postal Code Home Telephone Work Telephone Email Address Would like email reminders for appointments? Yes No Date of Birth (Day/Month/Year) Age Marital
More informationMedicare Article: Part I Understanding Medicare
Medicare Article: Part I Understanding Medicare Medicare is the largest purchaser of managed care and the largest health payer in the country. Supplying coverage for over 43 million Americans and growing
More informationPatient Re-Examination Form
Harrisburg Family Chiropractic 220 S. Cliff Ave. Ste 106 Harrisburg SD 57032 (605) 767-7463 Name: Date: / / Patient Re-Examination Form Please fill out the information that has changed since your last
More informationPatient Profile. Full Name: Address: Work Phone: Date of Birth: Social Security #: (Circle One) Full Time / Part Time. Emergency Contact: Number:
Patient Profile Full Name: Address: City: State: Zip Code: Home Phone: Cell Phone: Work Phone: Date of Birth: Social Security #: Email Address: Employer: (Circle One) Full Time / Part Time Emergency Contact:
More informationNOT DESIGNATED FOR PUBLICATION
NOT DESIGNATED FOR PUBLICATION BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. E907058 HATTIE M. MALONE, EMPLOYEE TRIDENT AUTOMOTIVE, EMPLOYER TRAVELERS PROPERTY & CASUALTY, INSURANCE CARRIER
More informationPost-op / Pre-op Page (ALREADY DONE)
Post-op / Pre-op Page (ALREADY DONE) We offer individualized treatment plans based on your physician's recommendations, our evaluations, and your feedback. Most post-operative and preoperative rehabilitation
More informationPATIENT FEE SCHEDULE As of January 1, 2017
TERMS OF ACCEPTANCE When a patient seeks chiropractic care and we accept such a patient for care, it is essential for both to be working towards the same objective. Chiropractic has only one goal. It is
More informationHistory of Present Condition
Name: Date: Address: City: Province: Postal Code: Home Phone: Cell Phone: Work Phone: Email: Marital Status: Name Of Family Physician (MD): Age: Occupation: Employer: Extended Health Care Company: Policy
More informationModule Eight. Application of Health Assessment NUR 225. Physical examination of Musculoskeletal System. King Saud University. Collage of Nursing
King Saud University Collage of Nursing Medical Surgical Nursing depart Application of Health Assessment NUR 225 Module Eight Physical examination of Musculoskeletal System Obtaining a health history Ask
More informationSession Objectives. Why We Need to Diagnose 4/2/18. Diagnosis: Defining the Patient Problem A prerequisite for treatment
Diagnosis: Defining the Patient Problem A prerequisite for treatment Marcia Spoto PT, DC, OCS Nazareth College of Rochester Session Objectives 1. Appreciate the role of Physical Therapist (PT) diagnosis
More informationBACK PAIN. Disclaimer. Integrated web marketing. Multimedia Health Education
BACK PAIN Disclaimer This movie is an educational resource only and should not be used to make a decision on. All decisions about surgery must be made in conjunction with your surgeon or a licensed healthcare
More informationAcknowledgment of Clinic Terms
Acknowledgment of Clinic Terms Our GOAL The goal of CHIRO-FIT, Inc. is to detect and correct subluxations of the spine and body. We do not focus on the treatment of pain and disease, instead aim to help
More informationFirst Name Middle Last Today s Date / / Age Male/Female Date of Birth / / SS# - - Address City State ZIP Phone: Home Cell Phone Provider Address
First Name Middle Last Today s Date / / Age Male/Female Date of Birth / / SS# - - Address City State ZIP Phone: Home Cell Phone Provider Email Address Do you have Medicaid? Y / N (present your card to
More informationUse the Physician Extender modifier for non-physician services. Additional acupuncture information is available later in this chapter.
Chapter 18 Chiropractic Services Definition Chiropractic services are medically necessary therapies that employ manipulation and specific adjustment of body structures, such as the spinal column, provided
More informationPhysical Therapy. Physical Therapy Payment Policy Page 1
Physical Therapy I. Policy University Health Alliance (UHA) will reimburse for physical therapy when it is determined to be medically necessary and when it meets the medical criteria guidelines (subject
More informationAcute Lower Back Pain. Physiotherapy department
Acute Lower Back Pain Physiotherapy department Back pain is a common condition and in the UK it affects 7 out of 10 people at some point in their lives. Back pain can be very uncomfortable but it is not
More informationExtended Health Care Company Do you need any help retaining information about your health insurance coverage? Yes No
PATIENT ENTRANCE FORM Date Circle: Male Female Name Birth Date (dd/mm/yy) Age Address Apt # City Province Postal Code Home # Cell # Work # E-MAIL Occupation Employer Name of Emergency Contact Contact #
More informationLIST YOUR HEALTH CONCERNS BELOW
Date / / HEALTH PROFILE T C E X Name D.O.B. / / Age Male/Female Address City State Zip Phone: Home Cell Cell Phone Carrier: Email Address Occupation Employer s Name _ Single / Married / Divorced / Widowed
More information405 Firemans Ave LaVale, Maryland 21502
Dec 19, 2016 CHIEF COMPLAINT: Iris presents with a chief complaint involving her lower lumbar and sacral region, left sacroiliac region and left anterior hip and groin. ONSET OF SYMPTOMS Iris states this
More informationWorkers Compensation Questionnaire. Name: Address: Telephone: City: State: Zip: Social Security Number: Cell Phone: Home phone: Work Phone:
Workers Compensation Questionnaire Name: Address: Telephone: City: State: Zip: Social Security Number: Email: Cell Phone: Home phone: Work Phone: Date of birth Sex: Male Female Marital States S M D W Date
More informationLIST RESTRICTED ACTIVITY: CURRENT ACTIVITY LEVEL USUAL ACTIVITY LEVEL
Whom may we thank for referring you to this office Today s Date: PATIENT DEMOGRAPHICS? HRN: Name: Birth Date: Age: Male Female Address: City: State: Zip: E mail Address: Home Phone: Mobile Phone: Marital
More informationCox Technic Decompression Spinal Manipulation Resolves Symptoms Associated with a 17mm L3-4 Disc Extrusion
Cox Technic Case Report #142 published at www.coxtechnic.com (sent 4/4/15) 1 Cox Technic Decompression Spinal Manipulation Resolves Symptoms Associated with a 17mm L3-4 Disc Extrusion submitted by Sara
More informationNorth American Spine Society Public Education Series
Herniated Cervical Disc North American Spine Society Public Education Series What Is a Herniated Disc? The backbone, or spine, is composed of a series of connected bones called vertebrae. The vertebrae
More information