Podiatric Practice Templates

PODIATRIC

PRACTICE

TEMPLATES

BRADIE BRITT

JESSICA VERVOORT

KENNETH OMS

SUZANNE JEAN-BAPTISTE

Brooks Foot & Ankle

Associates

Medicine and Surgery of the

Foot and Ankle

2201 E Nine Mile Rd Pensacola, FL 32514

Telephone : 850-479-6250

Fax : 850-479-6247

Email : info@

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Contents

List of Figures ................................................................................................................................................ 6

Introduction .................................................................................................................................................. 8

Dermatology ................................................................................................................................................. 8

Benign Neoplasm/Lesion of uncertain behavior ...................................................................................... 8

Dermatitis - Established Patient - Biopsy - AFC....................................................................................... 10

Dermatological Exam Normal ................................................................................................................. 12

Foreign Body Health & Physical .............................................................................................................. 12

Hyperkeratosis- Initial ............................................................................................................................. 15

Hyperkeratosis - Follow-up ..................................................................................................................... 18

Hyperkeratosis Debridement .................................................................................................................. 19

Incision & Drainage ¨C Established Patient .............................................................................................. 19

Incision & Drainage ¨CNew Patient .......................................................................................................... 20

Ingrown Nail ¨C Follow-up ........................................................................................................................ 22

Kissing corn ............................................................................................................................................. 23

Lesion Description ................................................................................................................................... 25

Nail Avulsion - Initial ............................................................................................................................... 25

Nail Avulsion - Follow-up ........................................................................................................................ 27

Onychomycosis - Established Patient ..................................................................................................... 27

Onychomycosis - New Patient ................................................................................................................ 29

Phenol and Alcohol Matrixectomy ......................................................................................................... 31

Phenol and Alcohol Matrixectomy ¨C Established Patient ....................................................................... 32

Phenol and Alcohol Matrixectomy ¨C New Patient .................................................................................. 33

Partial Nail Avulsion ¨C New Patient ........................................................................................................ 35

Partially Avulsed Nail .............................................................................................................................. 37

Pigmented Lesion .................................................................................................................................... 39

PinPointe - Initial ..................................................................................................................................... 41

PinPointe - Follow-up .............................................................................................................................. 44

Ulceration - Initial Visit............................................................................................................................ 45

Ulceration - Follow-up ............................................................................................................................ 47

Ulceration of Toe - Initial ........................................................................................................................ 48

Verruca - Initial........................................................................................................................................ 51

Verruca - Follow-up................................................................................................................................. 53

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Musculoskeletal .......................................................................................................................................... 53

Achilles Tendonitis - Initial ...................................................................................................................... 53

Achilles Tendonitis - Follow-up ............................................................................................................... 57

Achilles Wrap .......................................................................................................................................... 58

Ankle Exam.............................................................................................................................................. 58

Ankle instability/Sprain - Initial ............................................................................................................... 59

Ankle Sprain ............................................................................................................................................ 62

Aspiration ................................................................................................................................................ 63

Bunion Exam ........................................................................................................................................... 63

Bunion - Initial ......................................................................................................................................... 64

Bunion - Follow-up .................................................................................................................................. 65

Calcaneal Apophysitis - Initial ................................................................................................................. 66

Capsulitis - Initial ..................................................................................................................................... 69

Capsulitis - Follow-up .............................................................................................................................. 72

Charcot - AFO .......................................................................................................................................... 72

Contusion Foot/Toe - Initial Visit ............................................................................................................ 76

EPAT ........................................................................................................................................................ 78

ETOH Injection ........................................................................................................................................ 79

ETOH Injection ........................................................................................................................................ 80

Excision Foreign Body ............................................................................................................................. 80

Fracture - Initial Visit ............................................................................................................................... 82

Fracture - Follow-up Visit ........................................................................................................................ 85

Gait Analysis ............................................................................................................................................ 85

Gout - Initial Visit .................................................................................................................................... 86

Gout - Follow-Up Visit ............................................................................................................................. 88

Hallux Rigidus - Initial Visit ...................................................................................................................... 89

Hallux Rigidus ¨C Follow-up - Steroid Injection ........................................................................................ 92

Joint Injection.......................................................................................................................................... 93

Hallux Valgus ........................................................................................................................................... 93

Hammertoe - Initial Visit ......................................................................................................................... 94

Hammertoe - Initial Visit - Arthroplasty.................................................................................................. 97

Hammertoe ¨C Follow-up ....................................................................................................................... 100

Heel Exam - Ortho Exam ....................................................................................................................... 101

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Joint Injection........................................................................................................................................ 101

Osteoarthritis - Initial Visit .................................................................................................................... 102

Osteoarthritis Follow-up ....................................................................................................................... 104

Peroneal Tendonitis .............................................................................................................................. 105

Pes Planus ............................................................................................................................................. 107

Plantar Fasciitis - Initial Visit ................................................................................................................. 111

Plantar Fasciitis - D/C ............................................................................................................................ 114

Plantar Fasciitis - Follow-up - Steroid Injections ................................................................................... 115

Plantar Fasciitis - Follow-up - Surgery Recommended ......................................................................... 117

Plantar Fibroma .................................................................................................................................... 118

Posterior Tibial Tendonitis - Initial Visit ................................................................................................ 122

Posterior Tibial Tendonitis - Follow-up ................................................................................................. 124

Sesamoiditis ¨C Initial Visit ..................................................................................................................... 126

Sinus Tarsitis ¨C New Patient .................................................................................................................. 129

Tailor's Bunionette Deformity............................................................................................................... 132

Tarsal Tunnel Syndrome - Initial Visit ................................................................................................... 134

Tarsal Tunnel Syndrome ¨C Established Patient..................................................................................... 137

Tinea Pedis - Initial Visit ........................................................................................................................ 138

Tinea Pedis - Follow-up ......................................................................................................................... 140

Neurology.................................................................................................................................................. 141

Neuroma - Initial Visit ........................................................................................................................... 141

Neuroma - Follow-up - Steroid injection .............................................................................................. 143

Neuroma - Follow-up - Surgery Recommended ................................................................................... 144

Neuroma Discharge .............................................................................................................................. 146

Neuropathy ........................................................................................................................................... 146

Surgery ...................................................................................................................................................... 148

Amputation at the MPJ ......................................................................................................................... 148

Apligraft Op report................................................................................................................................ 149

Arthroplasty Digit .................................................................................................................................. 150

Biopsy epidermal Nerve density ........................................................................................................... 151

Biopsy Lesion......................................................................................................................................... 153

Chilectomy ............................................................................................................................................ 154

Informed Consent ¨C Achilles Tendon Repair ........................................................................................ 157

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CRYOSURGERY - Neuroma .................................................................................................................... 159

ENFD post op 1...................................................................................................................................... 162

ENFD post op 2...................................................................................................................................... 163

Exostectomy.......................................................................................................................................... 164

Exostectomy/Condylectomy of Toe op-report ..................................................................................... 166

Exostosis Distal toe ............................................................................................................................... 167

Flexor Tenotomy ................................................................................................................................... 168

Metatarsal Ostectomy .......................................................................................................................... 169

Post-op Arhtrodesis .............................................................................................................................. 171

Post-op Bunionectomy.......................................................................................................................... 172

Post-op Visit 3 ....................................................................................................................................... 173

Post-op Visit 4 ....................................................................................................................................... 173

Post-op Visit Follow-up ......................................................................................................................... 174

Post-op Visit Initial ................................................................................................................................ 175

Pre-op Consent ..................................................................................................................................... 176

Pre-op Consent ..................................................................................................................................... 176

Removal of Painful Internal Fixation ..................................................................................................... 179

Silver Bunionectomy ............................................................................................................................. 182

Correspondence ........................................................................................................................................ 183

EPAT Customer Satisfaction Survey ...................................................................................................... 183

Letter of Medical Necessity .................................................................................................................. 184

Letter of Medical Necessity - 64455 ..................................................................................................... 185

Letter of Medical Necessity - Orthotics or Diabetic Insoles/Shoes....................................................... 185

Post-op Instructions .............................................................................................................................. 186

Post-op Instructions - Matrixectomy .................................................................................................... 189

Post-op Instructions - Verruca .............................................................................................................. 191

Durable Medical Equipment ..................................................................................................................... 192

AFO Prescription - Casting .................................................................................................................... 192

AFO Prescription - Mini-templates ....................................................................................................... 192

AFO Dispensing ..................................................................................................................................... 192

AFO ¨C Follow-up .................................................................................................................................... 193

Aircast Ankle Brace ............................................................................................................................... 194

Ankle Brace ........................................................................................................................................... 195

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