Cosmetic injectable treatment
United States | Cosmetics & aesthetics

Blank documentation outlines for US practice. Adapt to the encounter and your practice requirements; complete only findings and care actually documented.

ENCOUNTER
Patient name: [ ]
Date of birth: [ ]
Date and time of encounter: [ ]
Clinician: [ ]

PRE-PROCEDURE REVIEW
Indication, treatment areas and patient goals: [ ]
Interval history, medications, allergies and risk assessment: [ ]
Baseline findings and photographs if obtained: [ ]
Product-specific risks, benefits, alternatives and off-label use discussed if applicable: [ ]
Consent and site verification: [ ]

TREATMENT RECORD
Product name and manufacturer: [ ]
Lot number and expiration date: [ ]
Preparation or dilution if applicable: [ ]
Site, laterality, amount and unit for each injection: [ ]
Total amount administered and amount discarded: [ ]
Technique and equipment actually used: [ ]
Anesthetic if used: [ ]

POST-PROCEDURE ASSESSMENT
Immediate findings and patient response: [ ]
Adverse events and management if any: [ ]
Aftercare, warning symptoms and contact instructions discussed: [ ]
Follow-up timing: [ ]