Morton neuroma / intermetatarsal space injection

Form ID: mortons_neuroma_injection_us Type: Procedure Family: Peripheral nerve / soft tissue injection

Structured fields

Section	Field	Key	Default layer	Required
Safety	Consent discussion	`consent_phrase`	Global Default	Required
Safety	Time-out and safety screen	`timeout_phrase`	Global Default	Required
Safety	Allergy / infection / anticoagulant screen	`allergy_infection_anticoagulant_screen`	No Default	Required
Indication	Diagnosis	`diagnosis`	No Default	Required
Indication	Clinical indication / rationale	`clinical_indication`	No Default	Required
Indication	Side / level / site	`side`	No Default	Required
Indication	Baseline pain score and functional limitation	`baseline_pain_function`	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	Image saved / archive location	`image_saved`	No Default	Required
Technique	Transducer / equipment	`transducer_or_equipment`	Per-Form Default	Optional
Technique	Approach	`approach`	Per-Form Default	Required
Technique	Target / endpoint	`target`	Per-Form Default	Required
Technique	Needle/cannula	`needle`	Per-Form Default	Required
Technique	Needle visualization / localization	`needle_visualization`	No Default	Required
Technique	Aspiration / safety check result	`aspiration_result`	No Default	Required
Technique	Injection spread / resistance / observation	`injection_character`	No Default	Required
Injectate/Product	Injectate/product/device	`injectate_product`	Per-Form Default	Required
Injectate/Product	Dose / amount / concentration	`dose_volume`	Per-Form Default	Required
Injectate/Product	Local anesthetic / diluent	`diluent_anesthetic`	Per-Form Default	Optional
Injectate/Product	Total volume	`total_volume`	Per-Form Default	Required
Injectate/Product	Lot number / expiry	`lot_expiry`	No Default	Required
Outcome	Immediate response / post-procedure status	`immediate_response`	No Default	Required
Outcome	Complications / adverse events	`complications`	No Default	Required
Disposition	Post-procedure instructions	`post_procedure_instructions`	Global Default	Required
Disposition	Follow-up plan	`follow_up_plan`	Global Default	Required

Section

Field

Key

Default layer

Required

Safety

Consent discussion

consent_phrase

Global Default

Required

Safety

Time-out and safety screen

timeout_phrase

Global Default

Required

Safety

Allergy / infection / anticoagulant screen

allergy_infection_anticoagulant_screen

No Default

Required

Indication

Diagnosis

diagnosis

No Default

Required

Indication

Clinical indication / rationale

clinical_indication

No Default

Required

Indication

Side / level / site

side

No Default

Required

Indication

Baseline pain score and functional limitation

baseline_pain_function

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

Image saved / archive location

image_saved

No Default

Required

Technique

Transducer / equipment

transducer_or_equipment

Per-Form Default

Optional

Technique

Approach

approach

Per-Form Default

Required

Technique

Target / endpoint

target

Per-Form Default

Required

Technique

Needle/cannula

needle

Per-Form Default

Required

Technique

Needle visualization / localization

needle_visualization

No Default

Required

Technique

Aspiration / safety check result

aspiration_result

No Default

Required

Technique

Injection spread / resistance / observation

injection_character

No Default

Required

Injectate/Product

Injectate/product/device

injectate_product

Per-Form Default

Required

Injectate/Product

Dose / amount / concentration

dose_volume

Per-Form Default

Required

Injectate/Product

Local anesthetic / diluent

diluent_anesthetic

Per-Form Default

Optional

Injectate/Product

Total volume

total_volume

Per-Form Default

Required

Injectate/Product

Lot number / expiry

lot_expiry

No Default

Required

Outcome

Immediate response / post-procedure status

immediate_response

No Default

Required

Outcome

Complications / adverse events

complications

No Default

Required

Disposition

Post-procedure instructions

post_procedure_instructions

Global Default

Required

Disposition

Follow-up plan

follow_up_plan

Global Default

Required

Narrative template

Procedure: Morton neuroma / intermetatarsal space injection - ultrasound-guided
Indication: {{diagnosis}}. Clinical rationale: {{clinical_indication}}. Side/site/level: {{side}}. Baseline pain/function: {{baseline_pain_function}}.

Consent and safety: {{consent_phrase}} {{timeout_phrase}} {{allergy_infection_anticoagulant_screen}}

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

Guidance: {{guidance}}. {{guidance_phrase}} Image documentation: {{image_saved}}.

Technique: Using {{transducer_or_equipment}}, {{approach}}. A {{needle}} was advanced toward {{target}}. Localization/visualization: {{needle_visualization}}. Aspiration/safety check: {{aspiration_result}}. Injection/lesion/procedural observation: {{injection_character}}.

Injectate/product/device: {{injectate_product}}. Dose/amount: {{dose_volume}}. Local anesthetic/diluent: {{diluent_anesthetic}}. Total volume: {{total_volume}}. Lot/expiry: {{lot_expiry}}.

Outcome: Immediate response/status: {{immediate_response}}. Complications/adverse events: {{complications}}.

Disposition: {{post_procedure_instructions}} Follow-up: {{follow_up_plan}}

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