Sample Report: Occupational Therapy Discharge Summary
History: This patient participated in the occupational therapy portion of the pain management center program for 24 days. He participated in a graduated activity program of upper extremity flexibility...
View ArticleSample Report: Open Reduction and Internal Fixation of Hip Fracture
Preoperative Diagnosis: Intertrochanteric fracture, left hip. Postoperative Diagnosis: Intertrochanteric fracture, left hip. Procedure: Open reduction and internal fixation of intertrochanteric...
View ArticleSample Report: Orthofix External Fixator Application
Ilizarov Frame Removal/ Occupational Therapy Discharge Summary/ Open Reduction and Internal Fixation of Hip Fracture/ Orthofix External Fixator Application Preoperative Diagnoses 1. Achondroplasia. 2....
View ArticleSample Report: Outpatient Toenail Removal
Subjective: The patient returns today for removal of his left great toenail. PARQ held previously. Patient consented today. Anesthesia: Digital anesthetic block with 2 cc of 1:1 mixture of 2% Xylocaine...
View ArticleSample Report: Pain Management Initial Evaluation
Presenting Characteristics: The patient is a 57-year-old married Caucasian female. She presented herself for interview dressed and groomed appropriately and casually. Interpersonal presentation was...
View ArticleSample Report: Pain Management Initial Evaluation/Physical Therapy Final...
Primary Diagnosis: Right basal ganglia, temporal lobe infarct. Treatment Diagnosis: Decreased functional mobility, inability to ambulate. Treatment Received Today: Functional training, sit to stand...
View ArticleSample Report: Physical Therapy Initial Evaluation
Chief Complaint: Pain in the right buttock, extending down the right lateral thigh and into the foot. History of Present Illness: This patient reports that she has had pain in the right buttock that...
View ArticleSample Report: Plate and Screw Hardware Removal
Preoperative Diagnosis: Metatarsalgia, left foot. Postoperative Diagnoses 1. Metatarsalgia, left foot. 2. Stable nonunion, left first metatarsophalangeal joint. Operations Performed 1. Removal of...
View ArticleRules
Stage, Type, and Fracture Classifications Lowercase the words "stage" and "type," and use roman numerals. For subdivisions of stages, follow The AAMT Book of Style rules for cancer classifications, and...
View ArticleSURGICAL INSTRUMENTS
There are several classes of surgical instruments: Graspers, especially tweezers and forceps Clamps and occluders for blood vessels and other organs Retractors, used to spread open skin, ribs and other...
View ArticleInstrument List According to Sizes and Specifications (0.18" - 5WIRE)
Below given is an instrument list according to sizes and specifications. However, such precise specification is not required in transcription unless and until the dictator is dictating it. .018" X 60CM...
View ArticleInstrument List According to Sizes and Specifications (6 FR - AVIAN BONE...
6 FR NASOGASTRIC FEEDING TUBE, 35CM LONG, - NON STERILE 6 FR PERCUTANEOUS NEPHROSTOMY SET 6 FR ROUND TIP URETERAL CATHETER L 6 FRENCH FALLOPOTORQUE CANNULA 6 FRENCH NASOGASTRIC FEEDING TUBE, 20CM LONG...
View ArticleInstrument List According to Sizes and Specifications (B.A.L. CATHETER – COOK...
B.A.L. CATHETER, 240CM LONG - NON STERILE B.A.L. CATHETER, 300CM LONG - NON STERILE Babcock Tissue Forceps BABYTOME WITH INTRO CATHETER Backhaus Towel Clamps BAGLEY URETEROSCOPIC BALLOON CATHETER BALL...
View ArticleInstrument List According to Sizes and Specifications (COOK CRICOTHYROTOMY –...
COOK CRICOTHYROTOMY CATHETER SET COOK CYSTOSTOMY CATHETER COOK CYSTOSTOMY CATHETER ACCESSORY SET COOK DRAINAGE POUCH SET COOK DRAINAGE POUCH SET (500 CC) COOK DRAINAGE POUCH SINGLE 500CC (STERILE) COOK...
View ArticleInstrument List According to Sizes and Specifications (E.R.C.P CATHETER –...
E.R.C.P CATHETER WITH PRECURVED TAPER E.R.C.P. CATHETER E.R.C.P. CATHETER LONG TAPER M/TIP E.R.C.P. CATHETER NON-TAPERED/BLUNT GLO-TIP E.R.C.P. CATHETER SHORT TAPER M/TIP E.R.C.P. CATHETER WITH METAL...
View ArticleInstrument List According to Sizes and Specifications (HABER RAMP CATHETER –...
HABER RAMP CATHETER Hand Held Retractors HAND PIECE ONLY - COMPONENTS FOR MOUTH ASPIRATION LINE Hand Towel HARE NEPHROSCOPY TRACT CATHETER HARE NEPHROSTOMY DRAINAGE CATHETER HARRISON FETAL BLADDER...
View ArticleInstrument List According to Sizes and Specifications (MEMORY POLYP – PVA FOAM)
MEMORY POLYP RETRIEVAL BASKET MENCINI DOUBLE BALLOON HYSTEROSALPINGOGRAHY MENCINI DOUBLE BALLOON HYSTEROSALPINGOGRAPHY MENNUTI SAMPLING NEEDLE SET METAL INTRODUCER SET METAL STIFFENING STYLET METAL...
View ArticleInstrument List According to Sizes and Specifications (QUANTUM 20MM –...
QUANTUM 20MM BALLOON DILATOR QUANTUM BALLOON DILATOR QUANTUM BILIARY INFLATION DEVICE QUANTUM INFLATION DEVICE QUANTUM TTC BILIARY BALLOON DILATOR QUANTUM TTC BILIARY BALLOON DILATOR QUANTUM TTC...
View ArticleInstrument List According to Sizes and Specifications (STAINLESS STEEL -...
STAINLESS STEEL THREADED WIRE - NON STERILE STAINLESS STEEL THREADED WIRE 70CM LENGTH - NON STERILE Stainless Steel Wire STAMEY NEEDLE STAMEY PERCUTANEOUS SUPRAPUBIC CATH SET STAMY NEEDLE STAND - CLEAR...
View ArticleInstrument List According to Sizes and Specifications ( VACUUM - ZONA...
VACUUM ASPIRATION SYRINGE VACUUM FILTER ASSEMBLY WITH SILICONE TUBING VACUUM FLUID TRAP VACUUM LINE WITH HYDROPHOBIC FILTER VACUUM LINES & FILTERS FOR K-MAR UNITS VACUUM LINES & FILTERS FOR...
View ArticlePT
Normal Values for Range of Motion of Joints Hip Flexion 0–125 Extension 115–0 Hyperextension 0–15 Abduction 0–45 Adduction 45–0 Lateral rotation 0–45 Medial rotation 0–45 Knee Flexion 0–130 Extension...
View ArticlePT 2
A Abdomen abduction abnormal abnormality Abrasion AC Joint acceleration acceleration of gravity accessory movement acquired disease active motion active range of motion Acute adduction adipose tissue...
View ArticleRange of Motion of Joints
Normal Values for Range of Motion of Joints Hip Flexion 0–125 Extension 115–0 Hyperextension 0–15 Abduction 0–45 Adduction 45–0 Lateral rotation 0–45 Medial rotation 0–45 Knee Flexion 0–130 Extension...
View ArticleDiagnostic Tests
All Diagnostic Tests CAT scan Positron Emission Tomography Magnetic Resonance Imaging Ultrasound X-ray MUGA scan Endoscopy Esophagogastroduodenoscopy Colonoscopy Endoscopic Retrograde...
View ArticleNormal Laboratory Values
Red Blood Cells RBC (Male) 4.2 - 5.6 M/µL RBC (Female) 3.8 - 5.1 M/µL RBC (Child) 3.5 - 5.0 M/µL White Blood Cells WBC (Male) 3.8 - 11.0 K / mm cubed WBC (Female) 3.8 - 11.0 K / mm cubed WBC (Child)...
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