Plan of Care Form Plan of Care Form Patient Name Date Treatment Goals Decrease PainImprove Biomechanical FunctionIncrease Range of MotionDecrease Muscle SpasmsIncrease MobilityDecrease WeightIncrease General FitnessImprove GaitDecrease Neuropathy SymptomsIncrease Activities of Daily LivingRestore Ligament FunctionImprove and Restore Prognosis Excellent: Uncomplicated case with continuing improvement expected and permanent residuals not expectedGood: Complicated case with continuing improvement expected and permanent residuals possibleFair: Complicated case with continuing improvement expected and permanent residuals probable Frequency of Visits: times per week for weeks then times per week for weeks Re-evaluate inweeks Refer to Physician Procedures and Treatment Sarapin Trigger Point Injections: times per week for weeks to the Joint Injections: Amniotic Tissue Allograft (Stem Cells)PRP Area: Peripheral Neuropathy Protocol: Upper ExtremityLower Extremity Weight Management: Medical Weight Loss Program (Based on Laboratory Tests)Natural Weight Loss Program Δ
