Escolar Documentos
Profissional Documentos
Cultura Documentos
Right Ear
Left Ear
ATF
Indicate on pictures above those areas on ear where reactive ear reflex points were found
Onset
End
1. Patient I.D.:_____________ 2. Date:______________ 3. Time:__________ 4. Time:_________
5. Patient Complaints Prior to Treatment: _______________________________________________
________________________________________________________________________________
6. Objective Body Assessments Prior to Treatment: (ie. symptoms, imitations in range of motion)
________________________________________________________________________________
________________________________________________________________________________
7. Auricular Diagnosis Observations: (i.e. regions of tenderness and electrodermal conductance)
________________________________________________________________________________
________________________________________________________________________________
8. Auriculotherapy Treatments Used: Acupuncture Needles Transcutaneous Stimulation
Electroacupuncture Acupoint Pellets Acupressure Other: ________________________
9. Auricular Points Treated: _________________________________________________________
________________________________________________________________________________
10. Patient Experience Following Treatment: ____________________________________________
________________________________________________________________________________
11. Objective Body Assessments Following Treatment : ___________________________________
|________________________________________________________________________________
[ For Office Use Only ] Clinic ID: ________________ Practitioner ID: ___________________
Copyright 1999 Free permission to use this form may be granted by writing to Dr. Terry Oleson at the following:
HCA, PMB 2657, 8033 Sunset Blvd., L.A., CA 90046 FAX: (323) 656-2084 E-mail: hca-la@worldnet.att.net