Podiatric Practice Templates
嚜燕ODIATRIC
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@
1
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 每 Established Patient .............................................................................................. 19
Incision & Drainage 每New Patient .......................................................................................................... 20
Ingrown Nail 每 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 每 Established Patient ....................................................................... 32
Phenol and Alcohol Matrixectomy 每 New Patient .................................................................................. 33
Partial Nail Avulsion 每 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
2
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 每 Follow-up - Steroid Injection ........................................................................................ 92
Joint Injection.......................................................................................................................................... 93
Hallux Valgus ........................................................................................................................................... 93
Hammertoe - Initial Visit ......................................................................................................................... 94
Hammertoe - Initial Visit - Arthroplasty.................................................................................................. 97
Hammertoe 每 Follow-up ....................................................................................................................... 100
Heel Exam - Ortho Exam ....................................................................................................................... 101
3
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 每 Initial Visit ..................................................................................................................... 126
Sinus Tarsitis 每 New Patient .................................................................................................................. 129
Tailor's Bunionette Deformity............................................................................................................... 132
Tarsal Tunnel Syndrome - Initial Visit ................................................................................................... 134
Tarsal Tunnel Syndrome 每 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 每 Achilles Tendon Repair ........................................................................................ 157
4
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 每 Follow-up .................................................................................................................................... 193
Aircast Ankle Brace ............................................................................................................................... 194
Ankle Brace ........................................................................................................................................... 195
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