Orthopaedic Templates

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2 point diagram	Hip - Bursitis of the Hip	Simple Knee
6 week CMC	Hip - Fracture Follow-up	simple knee medial meniscus
ACL Plan	Hip - Hemiarthroplasty Follow-up	Simple Knee normal
Alternating Grip Test	Hip - Hip Fracture F/U	Simple Knee VALGUS ARTHRITIS
Alternating Pinch Test	Hip - Inflamitory Arthritis of the Hip	Simple Lumbar Exam
Ankle	Hip - OP Note Osteoarthritis of Hip	Simple normal Total Knee
Ankle - Ankle Sprain	Hip - Osteoarthritis	simple shoulder
Ankle - Sprained Ankle	Hip - Osteoarthritis of the Hip	Simple Total Hip
ANKLE DISCUSSION	Hip - Quadriceps Stretching Excercises	simple total hip normal
Ankle Exam	Hip - THA - 10 Day	Simple Total Knee
ANKLE EXAM	Hip - THA - 6 Week	Simple Total Knee normal
Ankle Physical Exam	Hip Exam	Spine - 360 Spinal Fusion (long version)
Ankle Plan	Hip Exam	Spine - Ankylosing Spondylitis
Attestations	HIP EXAM	Spine - Back Pain
Back Pain Plan	Hip Osteoarthritis History	Spine - Cervical Discetomy/Fusion
Back Plan Surgery	Hyalgan Injection	Spine - Cervical Fracture
BOXED KNEE EXAM BOXED	Imaging Study	Spine - Cervical Radiculopathy
Brace Order Form	Initial Exam Knee	Spine - Cervical spondylosis
Carpal Tunnel Injection	Injection	Spine - Congenital Torticollis (Twisted Neck)
Cast Removal	Injection AC	Spine - Consultation
Casting	Injection- Ankle (cortisone)	Spine - Discoscopic/Endoscopic Lumbar Discectomy
Cervical Disc Plan	Injection Basal Joint	Spine - Followup
Cervical Exam	Injection Carpel Tunnel	Spine - Followup2
Cervical Exam	Injection Knee	Spine - Herniated Disk
Cervical Spine	Injection Medial Epicondyle	Spine - How to Keep Your Bones Healthy
Cervical spine exam 1	Instability of Passive Motion Thumb	Spine - How To Prevent Back Pain
Cervical spine exam, follow-up	Instability with Passive Motion Digit	Spine - IDET (Intradiscal Electrothermal Annulopla
Cervical spine exam, initial	Instability with Passive Motion Wrist	Spine - Initial Cervical Exam
Cervical spine exam, medical legal	Instruction for Lateral Epicondylitis	Spine - Injection S1 Transforaminal
Cervical spine, history	Knee	Spine - Injection Caudal Epidural w/Fluoro
Cervical Xray	Knee	Spine - Injection Lumbar Interlaminar Epidural
Cervical, discectomy/fusion complications	Knee - ACL Reconstruction	Spine - Injection Lumbar Medial Branch Block
Complete Spine	Knee - ACL Tear Education	Spine - Injection Lumbar Transforaminal Epidural
Consent	Knee - Anterior Knee Pain	Spine - Injection Lumbar Zygapophyseal Joint
Consent hip	Knee - Atheletes Knee	Spine - Injection Sacroiliac Joint
Consent hip arthroscopy	Knee - Boxed Knee	Spine - Intial Lumbar Exam
CONSENT KNEE	Knee - Knee Exam	Spine - Kids and Backpacks
Consent knee arthroscopy	Knee - Meniscal tear	Spine - Kyphosis (Curvature of the Spine)
Consent revision total knee	Knee - Meniscal Tear	Spine - Lifting Techniques for Home Caregivers
Consult / Referral Order Form	Knee - Osteoarthritis	Spine - Neck Brace Wear
Consult Plan	Knee - Pain Adult	Spine - Neck Pain
Cruciate Tear	Knee - TKA - 10 Day	Spine - Neck Sprain
CT / Bone scan / Doppler	Knee - TKA - 3 month	Spine - New Patient
CT Injection	Knee - TKA - 6 week	Spine - Non Op Follow up
CT Physical Exam	Knee Aspiration	Spine - Op Follow up
CT Plan Moderate	KNEE DISCUSSION	Spine - OP Note L3/L4 Decompression/Laminectomy
CT Plan Severe	Knee Exam	Spine - Osteoarthritis
CT Post Op	Knee Exam Complete	Spine - Osteoporosis
CTS DISCUSSION	KNEE EXAM COMPLETE	Spine - Osteoporosis and Falls
DeQuervains Plan	KNEE INJECTION	Spine - Osteoporosis Prevention Starts Earl
DeQuervains Post Op	Knee Range of Motion	Spine - Pain Management
Diagnostic Order	Lab Requisition	Spine - Post Op
Disc Plan	Lower Extremities	Spine - Post Op ACDF
Disc Plan 4	lumbar decompression visit 1	Spine - Post Op Cervical Spine
DISCUSSION	Lumbar Exam	Spine - Post Op Lumbar Decompression
DME Prescription	Lumbar plan	Spine - Post Op Lumbar Decompression
Dorsal Ganglion Cyst Plan Chronic	Lumbar Spine Exam	Spine - Post Op Lumbar fusion & instrumentation
Dorsal Ganglion Cyst Plan Early	Lumbar spine Exam 1	Spine - Post Op Microdiskectomy Exam
Dorsal Ganglion Cyst Plan Post Op	Lumbar spine exam, follow-up	Spine - Post Op Microdiskectomy Exam
DuPuytrens Contracture Plan Mild	Lumbar spine exam, initial	Spine - Pre Op
DuPuytrens Contracture Plan Severe	Lumbar spine exam, med legal	Spine - Pre Op ACDF
DuPuytrens Contracture Post Op	Lumbar Spine History	Spine - Pre Op Anterior cervical fusion
Elbow	Lumbar spine history	Spine - Pre Op Anterior lumbar fusion
Elbow - Arthritis and Total Elbow Replacement	Lumbar Spine Plan	Spine - Pre Op Anterior thoracic fusion
Elbow - Cubital tunnel exam- normal	Lumbar spine plan, conservative Rx	Spine - Pre Op Cervical surgery
Elbow - Cubital tunnel exam-bilateral	Lumbar spine selective nerve root block	Spine - Pre Op Corpectomy
Elbow - Elbow examination 1	Lumbar spine, fusion complications	Spine - Pre Op Discectomy
Elbow - Elbow examination 2	Lumbar surgical plan	Spine - Pre Op Dorsal Column Stimulator
Elbow - Epicondylosis	Med Rec Request	Spine - Pre Op Global reconstruction
Elbow - Tennis Elbow	MRI SCAN	Spine - Pre Op Implant failure
Elbow - Tennis elbow	MRI-Outside	Spine - Pre Op Irrigation & Debridement
Elbow - Tennis elbow normal	Musculature Test Elbow	Spine - Pre Op Kyphoplasty
ELBOW DISCUSSION	Musculature Test Finger Extrinisics	Spine - Pre Op Laminectomy
Elbow Exam	Musculature Test Finger Interossei	Spine - Pre Op Lumbar Decompression
ELBOW EXAM	Musculature Test Finger Intrinsics	Spine - Pre Op Lumbar Decompression & Diskectomy
ELBOW INJECTION	Musculature Test Finger Lumbricals	Spine - Pre Op Lumbar Microdiskectomy
Elbow Range Of Motion	musculature test lumbricals	Spine - Pre Op PLIF
Epicondylitis	Musculature Test Shoulder	Spine - Pre Op Posterior cervical fusion
Exam- Fx	Musculature Test Thumb Extrinsics	Spine - Pre Op Posterior Cervical surgery
EXAM- Hip	Nerve Occipital Nerve Block	Spine - Pre Op Posterior decompression
EXAM- Knee	New Patient Carpal Tunnel Injection	Spine - Pre Op Posterior spinal fusion
EXAM- Shoulder	New patient exam	Spine - Pre Op Scoliosis surgery
Final Carpal Tunnel Exam	New Wrist or Forearm exam	Spine - Preventing Back Pain: Tips for New Moms
Final Carpal Tunnel Plan	Non Op Plan	Spine - Review Diagnositc Studies
Finger	Normal Hip	Spine - Sciatica
FINGER EXAM	Normal Knee	Spine - Scoliosis Exam
Finger Extension Active	Osteoarthritis Carpometacarpal Joint Thumb Mild	Spine - Scoliosis in Children and Adolescents
Finger Extension Passive	Osteoarthritis Carpometacarpal Joint Thumb Plan	Spine - Spinal Fusion
Finger Flexion Active	Osteoarthritis Carpometacarpal Joint Thumb Post Op	Spine - Spinal Stenosis
Finger Flexion Passive	Osteoarthritis Carpometacarpal Joint Thumb Severe	Spine - Spondylolysis and Spondylolisthesis
FINGER/HAND/THUMB EXAM	Osteoarthritis Distal Interphalangea Severe	Spine - The Spine
Fingertip Flexion Distal Palm	Osteoarthritis Distal Interphalangeal Joints Plan	Spine - Warning Signs of Osteoporosis
Fingertip Flexion Midpalm	Osteoarthritis Distal Interphalangeal Joints Post	Spine - Whiplash
Fingertip Flexion Proximal Palm	Osteoarthritis Distal Interphalangeal Joints Sever	Spine evaluation summary
flouroscopic exam knee	Osteoarthritis Distal Interphalangeal Plan	spine exam normal
FOOT DISCUSSION	Osteoarthritis Distal Interphalangeal Post Op	Standard - Industrial Letter
foot normal	Osteoarthritis PIP Joint Mild	Standard - Inital Exam
Forearm ROM	Osteoarthritis PIP Joint Post Op	Standard - Letter
Forearm ROM Smart	Osteoarthritis PIP Joint Severe	Standard - NO SHOW
General Message	Osteoarthritis Plan	Standard - Nurse Note
General Referral	Osteoarthritis Wrist Plan Mild	Standard - Post Op
Girth Lower	Osteoarthritis Wrist Plan Post Op	Standard - Post Op Exam
Girth Upper	Osteoarthritis Wrist Plan Severe	Standard - Preferred Disclosures
Glenohumeral Joint Injection	Pain Scale	Standard - Radiology Study
Greater Trochanteric Bursa Steroid Injection	Pain Treatment Outcomes	Standard - SOAP NOTE
Grip Strength	Patient Precaution	Standard - Welcome Letter
Grip Strength Smart	Patient Report	Standard - Work Release
Hand	Ped - Cerebral palsy	Standard - Work Status
Hand - A Patients Guide To Carpal Tunnel	Ped - Club Foot	Standard - Work Status
Hand - Arthritis of the Hand	Ped - Congenital Torticollis (Twisted Neck)	Standard - Work Status Report
Hand - Arthritis of the Thumb	Ped - Coping with Juvenile Rheumatoid Arthritis	Standard - X-ray Report
Hand - Arthritis of the Wrist	Ped - Developmental dislocation (dysplasia) of the	Surg Check List
Hand - Arthritis Pip Dip	Ped - Flexible flatfoot in children	Surgery not recommended
Hand - Carpal Tunnel Exam	Ped - Forearm Fractures in Children	Surgery Order Form
Hand - Carpal tunnel exam- comprehensive	Ped - Growth Plate Fractures	Surgery Order Knee Arth
Hand - Carpal tunnel exam- normal	Ped - Intoeing	Surgery Order Shoulder Arthroscopy
Hand - Carpal tunnel exam- short	Ped - Juvenile rheumatoid arthritis	Surgery pt decide
Hand - Carpal tunnel exam-bilateral	Ped - Legg-Calve-Perthes Disease	Surgery recommended
Hand - Carpal Tunnel Syndrome	Phone Message	Surgery Scheduling
Hand - Carpal Tunnel Syndrome Treatment	Physical Exam	Surgery Sheet
Hand - CMC Joint Exam 1	Physical Findings	Surgery shoulder arthroscopy
Hand - Colles Fracture F/U	Physical Therapy	Surgery Total Hip
Hand - Contrast Bath for Hands	Physical Therapy Referral	Surgery Total Knee
Hand - DeQuervain Stenosing Tenosynovitis	Physicians Order	Surgical Consent
Hand - DeQuervains exam 1	Post Op Plan	Surgical Info
Hand - Dupuytrens - Bilateral	Postop Phone Call	Synvisc Injection
Hand - Dupuytrens - Left Hand	PreAuth Form	synvisc injection
Hand - Dupuytrens - Right Hand	Prescription Refill	Synvisc Injection
Hand - Dupuytrens Disease	Pre-Surgery Schedule	SYNVISC INJECTION Joint
Hand - Flexor Tendon Injuries	Procedure Synvisc Injection	Tennis Elbow Exam
Hand - Ganglion	Procedure Wound Care	Thoracic spine, follow-up
Hand - Ganglion Cyst - Bilateral	PT - Discharge Summary	Thoracic spine, history
Hand - Ganglion Cyst - Left	PT - Initial Evaluation	Thoracic spine, initial
Hand - Ganglion Cyst - Right	PT - Progress Note	Thoracic spine, medical legal
Hand - Ganglion Cysts	Refer Massage Therapy	Thumb Exam
Hand - General Hand Guide Lines	Refer PCE	Triage Note
Hand - Hand 1	Refer PT and & Occupational	Tricare Referral/Auth
Hand - Hand 2	Refer PT Back pain	Trigger Finger Injection
Hand - IME 1	Refer PT Edema and Pain Control	Trigger Finger Mild
Hand - Impairment Rating 5	Refer PT General	Trigger Finger Post Op
Hand - Impairment Rating 6	Refer PT Protocol	Trigger Finger Severe
Hand - Mucous Cyst	Referral Bone growth stimulator	WC - First Report
Hand - New Patient Hand Exam	Referral Default form	WC - P&S REPORT
Hand - OP Note Bilateral Endoscopic CT Release	Referral for wound care	WC - PR2
Hand - OP Note Dorsal Ganglion	Referral Hand Therapy	WC - PR3
Hand - OP Note Excision of Mass	Referral Letter	WC - PR4
Hand - OP Note Mucus Cyst with Osteophyte	Referral to other specialist	WC - Secondary PR-2
Hand - OP Note Palmar Ganglion	Return to Work Certificate	Work Release Form
Hand - OP Note Pin Removeal	Review of Systems	Wrist - Examination 1
Hand - OP Note Trigger Finger Release	Rheumatoid Arthritis Metacarpophalangeal Mild	Wrist - Examination 2
Hand - People who work at Computers	Rheumatoid Arthritis Metacarpophalangeal Post Op	Wrist Exam
Hand - Post Op Endoscopic Carpal Tunnel	Rheumatoid Arthritis Metacarpophalangeal Severe	WRIST EXAM
Hand - Post Op Evaluation complex	risks	X Ray Requisition
Hand - Post Op Evaluation normal	Rx Refill	X-ray / Fluoro Order Form
Hand - Post Op Instructions	Shoulder	X-ray 3 Views Right Thumb
Hand - Post Op Note	Shoulder	X-ray abnormal hip
Hand - Pre Op Exam Inpatient	Shoulder - Arthritis	X-ray abnormal knee
Hand - Pre Op Exam Minor	Shoulder - Arthroscopic Shoulder Surgery: Thermal	X-ray Ankle
Hand - Pre Op Exam Outpatient	Shoulder - Bone Up on Bone Loss	X-ray Ankle Fracture
Hand - Rheumatoid Arthritis	Shoulder - Broken Collarbone	X-ray Ankle ORIF
Hand - Thumb Exam 1	Shoulder - Coumadin Instructions	X-ray Foot
Hand - Trigger Digit Exam Bilateral	Shoulder - Impingement	X-ray Hand
Hand - Trigger Digit Exam Unilateral	Shoulder - Pain	X-ray Normal Elbow
Hand - Trigger Finger	Shoulder - Shoulder examination	X-ray Normal Foot
Hand - Trigger Finger Exam	Shoulder - Shoulder Impingement (Bursitis, Tendini	X-ray Normal Hand
Hand - Wrist Fracture	SHOULDER DISCUSSION	X-ray normal hip
Hand - Wrist or Forearm Exam	SHOULDER EXAM STANDARD	X-ray normal knee
Hand - Wrist Replacement Surgery	SHOULDER INJECTION	X-ray Normal Shoulder
Hand Complete	Shoulder ROM	X-ray total hip
HAND EXAM COMPLETE	SI Joint Injection	X-ray total knee
Hip	Simple Hip	X-rays, cervical spine
hip	simple hip arthritic	X-rays, thoracic spine
Hip - Activities following Hip Surgery	simple hip normal

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