Therapeutic Ultrasound Treatment Parameters Log

Logs therapeutic ultrasound treatment parameters, treatment area, sensory testing, and contraindication screening to support CPT 97035 documentation and patient safety.

Treatment Session Details

• Treatment Date
• Clinician Name
• Patient ID or Medical Record Number
  Use the minimum necessary identifier for charting. Do not enter SSN or other unnecessary PII.
• Treatment Location

Area Treated and Clinical Indication

• Body Area Treated
• Clinical Indication
• Treatment Goal

Ultrasound Parameters

• Frequency (MHz)
  Enter the ultrasound frequency used.
• Intensity (W/cm²)
  Enter the average intensity used during treatment.
• Duration (minutes)
• Mode
• Duty Cycle
  Complete only if pulsed mode was used, e.g., 20%, 50%, 1:4.
• Sound Head Movement

Pre-Treatment Safety Screening

• Sensory Testing Performed Before Application?
• Sensory Testing Result
• Contraindications Screened
  Select any contraindications or precautions identified during screening.
• Details of Contraindications or Precautions

Treatment Response and Follow-Up

• Patient Tolerance
• Immediate Response
• Follow-Up Instructions