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Osteopathic Physician
25-30 minutes

Osteopathic Intake Form

The s10.ai osteopath intake form template is expertly crafted for osteopathic practitioners to seamlessly capture patient information during initial consultations. This comprehensive template addresses essential areas such as patient demographics, chief complaints, history of present illness, and physical examination findings. Additionally, it includes sections for recording previous consultations, injuries, nutritional habits, and sleep quality, all vital for formulating a thorough treatment plan. By utilizing this template, osteopaths can optimize the intake process, ensuring all pertinent information is documented for superior patient care. This template is perfect for osteopaths aiming to elevate their documentation efficiency and accuracy.

4,156 uses
4.8/5.0
D
Dr. Michael Thompson
Template Structure

Organized sections for comprehensive clinical documentation

CC
[reason for consultation] [referring individual]
SUBJECTIVE:
[patient demographics and referral information]
[primary complaint]
[current illness history]
[factors that worsen or alleviate symptoms]
[previous treatments]
[physical activity and exercise routine]
[employment information]
[symptom onset and history]
CONSULTs [other physicians consulted and their findings] [delete line if not mentioned]
INJURIES [list of injuries, accidents, including MVAs, FALLs] [delete line if not mentioned]
JOINTS: [any other pain, especially in BACK/NECK] [delete line if not mentioned]
TOXINS: [Hg dental amalgams, occupational, military, or other toxin exposure] [delete line if not mentioned]
NUTRITION: [dietary habits, standard American diet or alternative] [delete line if not mentioned]
I.D.: [COVID, Lyme, Tickborne diseases, shingles, pneumonia, post-operative] [delete line if not mentioned]
TESTING: [testing for Lyme or other Tickborne diseases and results] [delete line if not mentioned]
MRI/XRAY: [imaging results] [delete line if not mentioned]
LABS: PCP routine labs, specialist RA or AUTOIMMUNE labs [delete line if not mentioned]
SLEEP QUALITY: interrupted or affected by pain [delete line if not mentioned]
MEDICATIONS: [list of all supplements, topicals, and prescriptions] [delete line if not mentioned]
Look at SURESCRIPTS, only clinicians can access this, not Kims/Sarahs
ALLERGIES: [list of allergies] [delete line if not mentioned]
Objective
PHYSICAL EXAM:
PHYSICAL EXAM:
GENERAL: Alert, not in acute distress
HEENT: EOMI. Sclerae anicteric, conjunctivae clear.
NECK: no asymmetry
LUNGS: Respirations even and unlabored, no dyspnea
NEURO: Awake, alert, oriented x3; no focal neurologic deficits.
MUSCULOSKELETAL: [musculoskeletal findings]
ASSESSMENT:
[diagnosis 1]
[diagnosis 2]
[diagnosis 3]
[diagnosis 4]
PLAN
[details of treatment plan]
[specific treatment methods and durations]
[pain management recommendations]
[follow-up visit recommendations]
Sample Clinical Note

Example of completed documentation using this template

CC  
Chronic lower back pain referred by Dr. Emily Johnson  
SUBJECTIVE:  
John Doe, a 45-year-old male, was referred by Dr. Emily Johnson for chronic lower back pain. The primary complaint is ongoing lower back pain persisting for the past six months. The pain worsens with prolonged sitting and is alleviated by standing and stretching. The patient has previously undergone physical therapy with limited relief. He maintains a moderate exercise regimen, including walking and light weightlifting. John is employed as a software engineer, which requires extended periods of sitting. The pain originated after a minor fall while hiking.  
CONSULTs: The patient has consulted a chiropractor who suggested osteopathic treatment.  
INJURIES: Minor fall while hiking six months ago.  
JOINTS: Occasional neck stiffness.  
NUTRITION: Adheres to a balanced diet with occasional fast food.  
I.D.: No history of COVID or other infectious diseases.  
TESTING: No testing for Lyme or other tickborne diseases.  
MRI/XRAY: MRI indicates mild lumbar disc degeneration.  
LABS: Routine labs are within normal limits.  
SLEEP QUALITY: Sleep is occasionally disrupted by pain.  
MEDICATIONS: Takes ibuprofen as needed for pain.  
ALLERGIES: No known allergies.  
Objective  
PHYSICAL EXAM:  
GENERAL: Alert, in no emergent distress  
HEENT: EOMI. Sclerae anicteric, conjunctivae clear.  
NECK: no asymmetry  
LUNGS: Respirations even and unlabored, no dyspnea  
NEURO: Awake, alert, oriented x3; no focal neurologic deficits.  
MUSCULOSKELETAL: Tenderness in the lower lumbar region, limited range of motion in the lumbar spine.  
ASSESSMENT:  
1. Chronic lower back pain  
2. Lumbar disc degeneration  
3. Neck stiffness  
4. Musculoskeletal strain  
PLAN  
Initiate osteopathic manipulative treatment (OMT) focusing on the lumbar spine, twice a week for four weeks. Recommend stretching exercises and ergonomic adjustments at work. Prescribe a non-steroidal anti-inflammatory drug (NSAID) for pain management as needed. Schedule a follow-up visit in four weeks to assess progress.
Clinical Benefits

Key advantages of using this template in clinical practice

  • The comprehensive clinical template is designed to streamline patient evaluations and enhance diagnostic accuracy for healthcare professionals. This template meticulously captures essential patient information, including demographics, chief complaints, and detailed history of present illness, ensuring a thorough understanding of each case. It incorporates high-search healthcare keywords to facilitate easy access and retrieval of patient data. Clinicians can document subjective findings such as aggravating and relieving factors, treatment history, and lifestyle details, alongside objective physical exam results. The template also allows for the inclusion of consults, injuries, joint issues, toxin exposures, nutritional habits, infectious disease history, and diagnostic testing results, providing a holistic view of the patient's health. With sections dedicated to sleep quality, medications, and allergies, it ensures no detail is overlooked. The assessment and plan sections guide clinicians in formulating precise diagnoses and effective treatment plans, including pain management and follow-up recommendations. By adopting this template, healthcare providers can enhance clinical documentation efficiency, improve patient care outcomes, and ensure compliance with medical standards.
Frequently Asked Questions

Common questions about this template and its usage

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Osteopathic Intake Form