Shoulder rotator cuff / biceps tendon PRP injection

Form ID: shoulder_tendon_prp_us Type: Procedure Family: PRP tendon/peritendon injection

Structured fields

Section	Field	Key	Default layer	Required	Quick text templates	History/exam sources
Safety	Consent discussion	`consent_phrase`	Global Default	Required	Reviewed today and no patient-specific contraindication identified.; Patient-specific exception documented in the free-text field.
Safety	Time-out and safety screen	`timeout_phrase`	Global Default	Required	Reviewed today and no patient-specific contraindication identified.; Patient-specific exception documented in the free-text field.
Safety	Allergy / infection / anticoagulant screen result	`allergy_infection_anticoagulant_screen`	No Default	Required	No known relevant allergies; no active infection symptoms; anticoagulant/antiplatelet status reviewed.; Medication/allergy list reviewed; no contraindication identified today.; Anticoagulant/antiplatelet plan reviewed and documented before proceeding.; Reviewed today and no patient-specific contraindication identified.; Patient-specific exception documented in the free-text field.	red_flags_neuro_screen; red_flag_exam_findings; current_medications
Indication	Diagnosis / indication	`diagnosis`	No Default	Required		condition_focus; pain_generator_impression; history_impression_plan
Indication	Clinical indication and failed conservative therapy	`clinical_indication`	No Default	Required	Persistent function-limiting pain despite conservative management; procedure offered for diagnostic and/or therapeutic benefit.; Symptoms, examination, and available imaging are concordant with the planned target.; Prior treatment response and patient goals reviewed; patient wishes to proceed.	presenting_complaint; pain_location_distribution; functional_limitations; prior_treatments; imaging_labs_tests; pain_generator_impression; procedural_target_assessment
Indication	Laterality / side	`side`	No Default	Required
Setup	Patient position	`patient_position`	Per-Form Default	Required
Setup	Skin preparation	`skin_prep`	Global Default	Required
Setup	Sterile setup	`sterile_setup`	Global Default	Required
Setup	Monitoring	`monitoring`	Global Default	Required
Guidance	Guidance modality	`guidance`	Per-Form Default	Required
Guidance	Guidance documentation phrase	`guidance_phrase`	Global Default	Required
Guidance	Images saved / archive location	`image_saved`	No Default	Required	Representative images saved to clinic imaging archive.; Image storage not technically feasible; guidance findings documented in note.; Fluoroscopic images stored according to clinic workflow.	imaging_labs_tests; procedural_target_assessment
Outcome	Immediate response / pain score change	`immediate_response`	No Default	Required	Tolerated well; immediate response to be assessed over the expected therapeutic window.; No immediate complication; post-procedure pain/function response reviewed before discharge.; Immediate pain score and functional response documented after reassessment.; No immediate complication observed.; Response will be reassessed after the expected onset window.	history_impression_plan; exam_plan
Outcome	Complications / adverse event	`complications`	No Default	Required	None.; No immediate adverse event observed.; Transient expected procedural discomfort only.; No immediate complication observed.; Response will be reassessed after the expected onset window.
Disposition	Post-procedure instructions	`post_procedure_instructions`	Global Default	Required	Post-procedure instructions and warning signs reviewed; patient advised to seek urgent care for concerning symptoms.; Activity modification, expected soreness, medication precautions, and red flags reviewed.; Written and verbal aftercare instructions provided according to clinic protocol.; Aftercare, red flags, and follow-up plan reviewed with patient.
Disposition	Follow-up plan	`follow_up_plan`	Global Default	Required	Follow-up arranged according to response and treatment plan; patient advised to track pain, function, and adverse effects.; Reassess pain score, functional change, medication use, and adverse effects at follow-up.; Patient will contact clinic earlier for concerning symptoms or inadequate response.; Aftercare, red flags, and follow-up plan reviewed with patient.	history_impression_plan; exam_plan; patient_preferences_affordability
Technique	Transducer / probe	`transducer`	Per-Form Default	Optional
Technique	Needle approach	`approach`	Per-Form Default	Required
Technique	Needle target	`target`	Per-Form Default	Required
Technique	Needle type / gauge / length	`needle`	Per-Form Default	Required
Technique	Needle visualization / path	`needle_visualization`	No Default	Required	Needle advanced under continuous in-plane visualization with tip position confirmed before injection.; Needle/cannula position confirmed with image guidance before treatment.; Needle path adjusted to avoid visible vessels and surrounding sensitive structures.	procedural_target_assessment; condition_specific_exam
Technique	Aspiration result	`aspiration_result`	No Default	Required	Negative; No blood or fluid aspirated before injection.; Not applicable.
Technique	Injection character / resistance / spread	`injection_character`	No Default	Required	Injectate spread was visualized in the intended tissue plane/target region without high resistance.; Injection proceeded smoothly without paresthesia, severe pain, or concerning resistance.; Injectate distribution was acceptable for the planned target.
Injectate/Product	PRP product/preparation	`injectate_product`	Per-Form Default	Required
Injectate/Product	PRP volume injected	`dose_volume`	Per-Form Default	Required
Injectate/Product	Lot number and expiry	`lot_expiry`	No Default	Required
Injectate/Product	Diluent / local anesthetic component	`diluent_anesthetic`	Per-Form Default	Optional
Injectate/Product	Total injectate volume	`total_volume`	Per-Form Default	Required
PRP Preparation	PRP system / kit	`prp_system`	Per-Form Default	Required
PRP Preparation	Blood draw volume	`blood_draw_volume`	No Default	Required
PRP Preparation	Spin protocol / processing details	`spin_protocol`	Per-Form Default	Required
Technique	Fenestration/peppering pattern if performed	`fenestration_pattern`	No Default	Optional
Recommended next procedure	Recommended next procedure date	`next_procedure_date`	No Default	Required
Recommended next procedure	Medication choice	`next_procedure_medication_choice`	Per-Form Default	Required
Recommended next procedure	Dose	`next_procedure_dose`	Per-Form Default	Required
Recommended next procedure	Technique	`next_procedure_technique`	Per-Form Default	Required
Recommended next procedure	Patient position	`next_procedure_patient_position`	Per-Form Default	Required
Recommended next procedure	Premedication	`next_procedure_premedication`	Per-Form Default	Optional
Recommended next procedure	Pre-procedure comments	`next_procedure_pre_procedure_comments`	Per-Form Default	Optional	Reassess indication, response to current procedure, contraindications, patient preference, and affordability before proceeding.; Repeat only if clinically indicated after response and safety review.; Confirm medication/product availability, consent, and interval safety before booking.	history_impression_plan; exam_plan; patient_preferences_affordability
Recommended next procedure	Intra-procedure comments	`next_procedure_intra_procedure_comments`	Per-Form Default	Optional	Use same technique unless anatomy, response, or safety considerations require modification.; Adjust target/approach based on updated exam, imaging, and response to previous procedure.; Document any change in guidance, target, needle/cannula, or device settings.
Recommended next procedure	Post-procedure comments	`next_procedure_post_procedure_comments`	Per-Form Default	Optional	Reassess response, adverse effects, function, and need for further treatment after the next procedure.; Track pain diary, functional goals, and medication change after the next procedure.; Review whether further repeat procedure remains appropriate before additional treatment.

Section

Field

Key

Default layer

Required

Quick text templates

History/exam sources

Safety

Consent discussion

consent_phrase

Global Default

Required

Reviewed today and no patient-specific contraindication identified.; Patient-specific exception documented in the free-text field.

Safety

Time-out and safety screen

timeout_phrase

Global Default

Required

Reviewed today and no patient-specific contraindication identified.; Patient-specific exception documented in the free-text field.

Safety

Allergy / infection / anticoagulant screen result

allergy_infection_anticoagulant_screen

No Default

Required

No known relevant allergies; no active infection symptoms; anticoagulant/antiplatelet status reviewed.; Medication/allergy list reviewed; no contraindication identified today.; Anticoagulant/antiplatelet plan reviewed and documented before proceeding.; Reviewed today and no patient-specific contraindication identified.; Patient-specific exception documented in the free-text field.

red_flags_neuro_screen; red_flag_exam_findings; current_medications

Indication

Diagnosis / indication

diagnosis

No Default

Required

condition_focus; pain_generator_impression; history_impression_plan

Indication

Clinical indication and failed conservative therapy

clinical_indication

No Default

Required

Persistent function-limiting pain despite conservative management; procedure offered for diagnostic and/or therapeutic benefit.; Symptoms, examination, and available imaging are concordant with the planned target.; Prior treatment response and patient goals reviewed; patient wishes to proceed.

presenting_complaint; pain_location_distribution; functional_limitations; prior_treatments; imaging_labs_tests; pain_generator_impression; procedural_target_assessment

Indication

Laterality / side

side

No Default

Required

Setup

Patient position

patient_position

Per-Form Default

Required

Setup

Skin preparation

skin_prep

Global Default

Required

Setup

Sterile setup

sterile_setup

Global Default

Required

Setup

Monitoring

monitoring

Global Default

Required

Guidance

Guidance modality

guidance

Per-Form Default

Required

Guidance

Guidance documentation phrase

guidance_phrase

Global Default

Required

Guidance

Images saved / archive location

image_saved

No Default

Required

Representative images saved to clinic imaging archive.; Image storage not technically feasible; guidance findings documented in note.; Fluoroscopic images stored according to clinic workflow.

imaging_labs_tests; procedural_target_assessment

Outcome

Immediate response / pain score change

immediate_response

No Default

Required

Tolerated well; immediate response to be assessed over the expected therapeutic window.; No immediate complication; post-procedure pain/function response reviewed before discharge.; Immediate pain score and functional response documented after reassessment.; No immediate complication observed.; Response will be reassessed after the expected onset window.

history_impression_plan; exam_plan

Outcome

Complications / adverse event

complications

No Default

Required

None.; No immediate adverse event observed.; Transient expected procedural discomfort only.; No immediate complication observed.; Response will be reassessed after the expected onset window.

Disposition

Post-procedure instructions

post_procedure_instructions

Global Default

Required

Post-procedure instructions and warning signs reviewed; patient advised to seek urgent care for concerning symptoms.; Activity modification, expected soreness, medication precautions, and red flags reviewed.; Written and verbal aftercare instructions provided according to clinic protocol.; Aftercare, red flags, and follow-up plan reviewed with patient.

Disposition

Follow-up plan

follow_up_plan

Global Default

Required

Follow-up arranged according to response and treatment plan; patient advised to track pain, function, and adverse effects.; Reassess pain score, functional change, medication use, and adverse effects at follow-up.; Patient will contact clinic earlier for concerning symptoms or inadequate response.; Aftercare, red flags, and follow-up plan reviewed with patient.

history_impression_plan; exam_plan; patient_preferences_affordability

Technique

Transducer / probe

transducer

Per-Form Default

Optional

Technique

Needle approach

approach

Per-Form Default

Required

Technique

Needle target

target

Per-Form Default

Required

Technique

Needle type / gauge / length

needle

Per-Form Default

Required

Technique

Needle visualization / path

needle_visualization

No Default

Required

Needle advanced under continuous in-plane visualization with tip position confirmed before injection.; Needle/cannula position confirmed with image guidance before treatment.; Needle path adjusted to avoid visible vessels and surrounding sensitive structures.

procedural_target_assessment; condition_specific_exam

Technique

Aspiration result

aspiration_result

No Default

Required

Negative; No blood or fluid aspirated before injection.; Not applicable.

Technique

Injection character / resistance / spread

injection_character

No Default

Required

Injectate spread was visualized in the intended tissue plane/target region without high resistance.; Injection proceeded smoothly without paresthesia, severe pain, or concerning resistance.; Injectate distribution was acceptable for the planned target.

Injectate/Product

PRP product/preparation

injectate_product

Per-Form Default

Required

Injectate/Product

PRP volume injected

dose_volume

Per-Form Default

Required

Injectate/Product

Lot number and expiry

lot_expiry

No Default

Required

Injectate/Product

Diluent / local anesthetic component

diluent_anesthetic

Per-Form Default

Optional

Injectate/Product

Total injectate volume

total_volume

Per-Form Default

Required

PRP Preparation

PRP system / kit

prp_system

Per-Form Default

Required

PRP Preparation

Blood draw volume

blood_draw_volume

No Default

Required

PRP Preparation

Spin protocol / processing details

spin_protocol

Per-Form Default

Required

Technique

Fenestration/peppering pattern if performed

fenestration_pattern

No Default

Optional

Recommended next procedure

Recommended next procedure date

next_procedure_date

No Default

Required

Recommended next procedure

Medication choice

next_procedure_medication_choice

Per-Form Default

Required

Recommended next procedure

Dose

next_procedure_dose

Per-Form Default

Required

Recommended next procedure

Technique

next_procedure_technique

Per-Form Default

Required

Recommended next procedure

Patient position

next_procedure_patient_position

Per-Form Default

Required

Recommended next procedure

Premedication

next_procedure_premedication

Per-Form Default

Optional

Recommended next procedure

Pre-procedure comments

next_procedure_pre_procedure_comments

Per-Form Default

Optional

Reassess indication, response to current procedure, contraindications, patient preference, and affordability before proceeding.; Repeat only if clinically indicated after response and safety review.; Confirm medication/product availability, consent, and interval safety before booking.

history_impression_plan; exam_plan; patient_preferences_affordability

Recommended next procedure

Intra-procedure comments

next_procedure_intra_procedure_comments

Per-Form Default

Optional

Use same technique unless anatomy, response, or safety considerations require modification.; Adjust target/approach based on updated exam, imaging, and response to previous procedure.; Document any change in guidance, target, needle/cannula, or device settings.

Recommended next procedure

Post-procedure comments

next_procedure_post_procedure_comments

Per-Form Default

Optional

Reassess response, adverse effects, function, and need for further treatment after the next procedure.; Track pain diary, functional goals, and medication change after the next procedure.; Review whether further repeat procedure remains appropriate before additional treatment.

Narrative template

Shoulder rotator cuff / biceps tendon PRP injection - ultrasound-guided

Indication: {{side}} procedure for {{diagnosis}}. {{clinical_indication}}

Consent / safety: {{consent_phrase}} {{timeout_phrase}} Safety screen: {{allergy_infection_anticoagulant_screen}}

Setup: The patient was positioned {{patient_position}}. Skin preparation: {{skin_prep}} Sterile setup: {{sterile_setup}} Monitoring: {{monitoring}}

Guidance: {{guidance_phrase}} Images: {{image_saved}}

Technique: Autologous PRP was prepared. Using {{guidance}} with a {{transducer}}, a {{needle}} was advanced via {{approach}} to {{target}}. Needle visualization/path: {{needle_visualization}} Aspiration: {{aspiration_result}} Injection/spread: {{injection_character}}

Product/injectate: {{injectate_product}}; {{dose_volume}}. Diluent/local anesthetic: {{diluent_anesthetic}}. Total volume: {{total_volume}}. Lot/expiry: {{lot_expiry}}.

PRP preparation: System: {{prp_system}}. Blood draw volume: {{blood_draw_volume}}. Spin protocol: {{spin_protocol}}. Fenestration: {{fenestration_pattern}}.

Outcome: Immediate response: {{immediate_response}} Complications: {{complications}}

Disposition: {{post_procedure_instructions}} {{follow_up_plan}}

Recommended next procedure: Date: {{next_procedure_date}}. Medication choice: {{next_procedure_medication_choice}}. Dose: {{next_procedure_dose}}. Technique: {{next_procedure_technique}}. Patient position: {{next_procedure_patient_position}}. Premedication: {{next_procedure_premedication}}. Pre-procedure comments: {{next_procedure_pre_procedure_comments}}. Intra-procedure comments: {{next_procedure_intra_procedure_comments}}. Post-procedure comments: {{next_procedure_post_procedure_comments}}.

Physician review required before signing in the EMR. Verify actual medications, doses, lot/expiry, devices, image documentation, response, complications, and follow-up.