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Patient Treatment Notes; Injection
Patient Treatment Notes; Injection
Patient Treatment Notes; Injection
1. Please record time and date of appointment *
*
2. Clinician Name
*
3. Three Points of Identification (verbal confirmation from patient required)
*
Name
Date of Birth
Addrss
4. Please ensure the client has completed the 'Medical Questionnaire'; this prerequisite must be fulfilled prior to the initiation of any treatment.
*
Form is complete
5. Why has the patient requested the IM injection today?
*
Anit-Ageing
Antioxidant
Detox
Low in Energy
Lethargic
Tired
Hair Health
For Hydration
Immune boost
Iron Deficiency
Muscle Therapy
Skin issues
Other
6. If 'Other' Please specify;
7. What Treatment has been recommended?
*
8. Has Client had an adverse reaction to IM Injection?
*
No
Yes
9. If 'Yes' please specify. Include Vitamin Name, Dosage, Batch Number, Expiry Date, Reaction & Action Taken.
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