DocuForms’ POD-3070 Heel Pain Report. Complaints of heel-pain, which often represents 20% of the complaints encountered in a typical podiatric practice, can be easily documented without use of lengthy dictation. DocuForms offers two forms for the management of heel pain. This is the first.
The Heel Pain Report, POD-3070 is an initial evaluation form that can be used:
When a new patient or established patient presents with a new problem of heel pain.
When there is a recurrence of heel pain.
To reassess and develop a new treatment plan because the patient is not progressing as anticipated.
The Heel Pain Report form presents the questions that podiatrists typically ask, so a patient’s replies can be quickly noted. For new patients you will also want to use the Patient History, POD-2010, and you may also want to use the Podiatric Physical Exam, POD-2020, or the Podiatric Services Report, POD-3030, to get a better understanding of the context of the patient’s problem.
The physical examination section of the form includes the location and severity of the pain palpated on all sides of the heel and arch. Space is provided throughout the exam for individualized comments.
A brief range-of-motion exam is available to give you a snapshot of the biomechanical nature of the foot and a separate section is provided to document any X-rays. The Assessment section lists many of the common diagnoses associated with heel pain. You can also quickly mark how the patient’s condition is progressing.
In the Procedure/Plan portion of the form you can easily document the treatment performed and the plan for future care. All of the common modalities for the treatment of heel pain are ready to be checked off. You can indicate that you have Performed, Educated or Recommended a treatment. You can mark whether or not the treatment was scheduled for Next visit or to be Considered later.
This section also enables you to quickly record what supplies and medications were Used, Dispensed or Rx’d. it’s important to know when and whom to charge for them. Many of these items need to either be billed to the insurance carrier or charged directly to the patient.
The form prompts you to properly document injections by recording drugs and dosage at each anatomical location.
The Plan section ends with areas to:
Show which labs you have ordered or are considering in the future.
Note your instructions for home care.
Indicate the additional systems that were examined and not found to be contributing to the heel pain complaint.
Direct a reader to other associated pertinent information in the medical chart.
Notation is made when the patient is to return and then sign the report.