M & M Home Care Massage Therapy Progress Note

1Demographics > 2Pain > 3Treatment > 4Billing > 5Review Your Entry
PATIENT NAME: PATIENT NAME: First Last
PATIENT DATE OF BIRTH: PATIENT DATE OF BIRTH: / MM / DD YYYY
TREATMENT LOCATION

TREATMENT LOCATION HOME VISIT (12) OFFICE VISIT (11) ASSIST LIVING FACILITY (13) GROUP HOME (14) TEMPORARY LODGING (16) PLACE OF EMPLOYMENT (18) SKILLED NURSING FACILITY (31) NON SKILLED NURSING FACILITY (32) OTHER (99) OTHER (99)
TREATMENT DATE TREATMENT DATE / MM / DD YYYY
TREATMENT STARTED: TREATMENT STARTED: : HH MM AM/PM
TREATMENT ENDED: TREATMENT ENDED: : HH MM AM/PM
PRESCRIBED AREAS OF TREATMENT
HEAD / NECK CHEST TRUNK ARM BACK / SHOULDER HIP LEG
SUBJECTIVE
INFORMATION OFFERED BY THE PATIENT:

THIS MAY INCLUDE: VERBAL QUESTIONS OR COMMENTS DIRECTED TO YOU REGARDING MASSAGE THERAPY, HOW THEY ARE FEELING TODAY, HOW THE MASSAGE SESSION FELT
OBJECTIVE
POSTURAL ASSESSMENT OF SPINE

POSTURAL ASSESSMENT OF SPINE NORMAL LORDOSIS KYPHOSIS SCOLIOSIS OTHER OTHER
POSTURAL ASSESSMENT OF PELVIS

POSTURAL ASSESSMENT OF PELVIS NORMAL TILT TWIST PROTRACT RETRACT OTHER OTHER
POSTURAL ASSESSMENT OF SHOULDERS

POSTURAL ASSESSMENT OF SHOULDERS NORMAL TILT TWIST PROTRACT RETRACT OTHER OTHER
EDEMA (SWELLING) PRESENT

EDEMA (SWELLING) PRESENT YES NO
LOCATION OF EDEMA/SWELLING:
PTTING EDEMA SCALE

PTTING EDEMA SCALE 1+ (2mm or less disappears immediately) 2+ (2-4mm few second rebound) 3+ (4-6mm 10-12 second rebound) 4+ (6-8mm >20 second rebound)
FINDINGS UPON PALPATION:

FINDINGS UPON PALPATION: INFLAMED/TENDER TO TOUCH SKIN IS COOL TO TOUCH SKIN IS HOT TO TOUCH SKIN IS NORMAL TEMPERATURE MOISTURE ON SKIN SURFACE FASCIAL ADHESIONS HYPERTONICITY HYPOTONICITY SCAR TISSUE AHESION(S) PRESENT TAUT BAND OF MUSCLE FIBERS ROPE-LIKE MUSCLES TRIGGER POINT(S) OTHER OTHER
IMPAIRED RANGE OF MOTION ASSESSED IN THE FOLLOWING AREAS:

IMPAIRED RANGE OF MOTION ASSESSED IN THE FOLLOWING AREAS: HEAD/NECK BACK/SHOULDERS RIGHT ARM LEFT ARM CHEST/TRUNK RIGHT HIP LEFT HIP RIGHT LEG LEFT LEG OTHER OTHER
ADDITIONAL NOTES:

M & M Home Care Massage Therapy Progress Note

M & M Home Care Massage Therapy Progress Note

PRESCRIBED AREAS OF TREATMENT

SUBJECTIVE

OBJECTIVE