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Run: Therapeutic Ultrasound Treatment Parameters Log

Log therapeutic ultrasound treatment parameters, safety screening, and patient response in one CPT 97035-ready form. Use it to document what was treated, how...

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Treatment Session Details

Treatment Date (required)

Clinician Name (required)

Patient ID or Medical Record Number (required)

Use the minimum necessary identifier for charting. Do not enter SSN or other unnecessary PII.

Treatment Location (required)

Area Treated and Clinical Indication

Body Area Treated (required)

Clinical Indication (required)

Treatment Goal (required)

Ultrasound Parameters

Frequency (MHz) (required)

Enter the ultrasound frequency used.

Intensity (W/cm²) (required)

Enter the average intensity used during treatment.

Duration (minutes) (required)

Mode (required)

Duty Cycle

Complete only if pulsed mode was used, e.g., 20%, 50%, 1:4.

Sound Head Movement (required)

Pre-Treatment Safety Screening

Sensory Testing Performed Before Application? (required)

Sensory Testing Result

Contraindications Screened (required)

Select any contraindications or precautions identified during screening.

Details of Contraindications or Precautions

Treatment Response and Follow-Up

Patient Tolerance (required)

Immediate Response

Follow-Up Instructions

Get your results

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Email (required)

Your name (optional)

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