KLIENTJOURNAL

Dato: ..........................

Navn:..........................................................................…………………………………………………… Alder: .........................

Adresse:..............................................................................................................................................Tlf. nr...........................

E-mail:....................................................................Arbejde/profession:..................................................................................

HELBREDSOPLYSNINGER
Allergier:..................................................................................................................................................................................

Medicin:...................................................................................................................................................................................

Kosttilskud:..............................................................................................................................................................................

Alkohol:............................................................................Tobak:............................................................................................
Kost:........................................................................................................................................................................................
Tidligere sygdomme:...............................................................................................................................................................
Evt. blodtryk:.....................................Blodsukker:............................................Højde:..............................Vægt:.....................

Behandling nr.: ..............

Aktuelle henvendelsesårsag:..................................................................................................................................................
................................................................................................................................................................................................
................................................................................................................................................................................................
................................................................................................................................................................................................
................................................................................................................................................................................................
................................................................................................................................................................................................

Den specifikke undersøgelse:................................................................................................................................................

................................................................................................................................................................................................
................................................................................................................................................................................................
................................................................................................................................................................................................
................................................................................................................................................................................................
................................................................................................................................................................................................
................................................................................................................................................................................................
Behandlingsplan:....................................................................................................................................................................
................................................................................................................................................................................................
................................................................................................................................................................................................
................................................................................................................................................................................................
Anbefalinger til klienten...........................................................................................................................................................
................................................................................................................................................................................................
................................................................................................................................................................................................
Klienten giver hermed sit samtykke til undersøgelse og journaloptagelse samt bekræfter at jeg mundtligt har givet information om
formål, forventede resultater samt mulige reaktioner efter behandlingen.

Dato:........../........20........ Behandlerstempel:

Klientens samtykke:................................................................
KLIENTJOURNAL

Observationer:
...................................................................................
...................................................................................
....................................................................................
...................................................................................
...................................................................................
..................................................................................
...................................................................................
...................................................................................
....................................................................................
...................................................................................
...................................................................................
..................................................................................
...................................................................................
Andet:
...................................................................................
...................................................................................
....................................................................................
...................................................................................
...................................................................................
..................................................................................
Næste gang:
...................................................................................
....................................................................................
....................................................................................

Symboler:
Arcing, aktiv energicyste

꞊ Dural Tube, spændt, hyperaktivt, irriteret

Bindevævets bevægelighed
Sammenhænge
KSR
a Foran (anterior)
P Bagpå (posterior)
Dato: ..........................
Behandling nr.:...........
KLIENTJOURNAL
Navn:..........................................................................………

Siden sidst:
...................................................................................
...................................................................................
....................................................................................
...................................................................................
....................................................................................
...................................................................................

Dagens behandling:
...................................................................................
...................................................................................
....................................................................................
...................................................................................
...................................................................................
..................................................................................
...................................................................................
..................................................................................
...................................................................................
Næste gang:
...................................................................................
....................................................................................

Symboler:
Arcing, aktiv energicyste

꞊ Dural Tube, spændt, hyperaktivt, irriteret

Bindevævets bevægelighed
Sammenhænge
KSR
a Foran (anterior)
P Bagpå (posterior)

Dato: ..........................
Behandling nr.:...........
Navn:..........................................................................………
KLIENTJOURNAL

Siden sidst:
...................................................................................
...................................................................................
....................................................................................
...................................................................................
....................................................................................
...................................................................................

Dagens behandling:
...................................................................................
...................................................................................
....................................................................................
...................................................................................
...................................................................................
..................................................................................
...................................................................................
..................................................................................
...................................................................................
Næste gang:
...................................................................................
....................................................................................

Symboler:
Arcing, aktiv energicyste

꞊ Dural Tube, spændt, hyperaktivt, irriteret

Bindevævets bevægelighed
Sammenhænge
KSR
a Foran (anterior)
P Bagpå (posterior)