Acupuncture worksheet 2026

1. Click ‘Get Form’ to open the acupuncture worksheet in the editor.
2. Begin by filling out the 'Patient' section. Enter the patient's first name, middle initial, last name, date of birth, and contact information including home and cell phone numbers.
3. Next, complete the 'Provider' section with your details such as provider's first and last name, specialty, TIN, NPI, and contact information.
4. In the 'Administrative' section, indicate whether this is a new condition or a follow-up. Provide relevant codes and descriptions for diagnoses.
5. Assess the patient's pain level over the past week using a scale from 0 to 10. List activities that are difficult for the patient due to their condition.
6. If this is an initial request for care, answer questions regarding current pain medication usage and re-occurrences of pain.
7. For follow-up requests, provide updates on the patient's response to care and any changes in medication usage.

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