Electroacupuncture Procedure Note

Date/Time: [Date and time of procedure; include start and end time if captured]

Location: [Facility/site and room]

Patient: [Patient name/identifier]

Performing Clinician: [Name, credentials]

Procedure Summary

[Brief 2–4 sentence summary of electroacupuncture using acupuncture needles with electrical stimulation, including: primary indication and treatment target; anatomic region(s) treated; treatment intent; procedure status: completed as planned / modified / aborted with reason.] (If indication is not documented, explicitly state "Indication not documented." Do not infer.)

Pre-Procedure Safety Screen

(Never leave safety-critical fields blank. Use Yes/No/Unknown explicitly. For repeat visits with no interval changes, use the repeat visit statement.)

• Implanted electrical devices: [Present / Absent / Unknown]; [Device type if present: pacemaker/ICD / neurostimulator / insulin pump / other]; [Clearance or mitigation if present]
• Pregnancy status: [Pregnant / Not pregnant / Unknown / N/A] (If unknown in a potentially pregnant patient, document mitigation such as deferring electrical stimulation or arranging testing.)
• Bleeding risk: [Anticoagulant use: Yes / No / Unknown]; [Antiplatelet use: Yes / No / Unknown]; [Known bleeding disorder: Yes / No / Unknown]; [Notes/mitigation if applicable]
• Skin integrity at planned sites: [Normal / Abnormal] (If abnormal, describe findings and locations.)
• Relevant precautions: [Seizure history: Yes / No / Unknown]; [Metal allergy: Yes / No / Unknown]; [Needle phobia/syncope history: Yes / No / Unknown]; [Sensory deficits: Yes / No / Unknown]; [Other precautions if applicable]
• Repeat visit statement: [Interval history reviewed; no contraindication changes reported. / N/A - initial visit]

Consent

[Consent obtained: verbal / written] for electroacupuncture after discussion of the nature and purpose of treatment, material risks (bruising/bleeding, soreness, vasovagal symptoms, rare infection; electrical stimulation-specific risks including skin irritation and involuntary muscle contraction), alternatives including no treatment, and opportunity for questions. Patient demonstrated understanding and agreed to proceed.

Asepsis and Sharps Safety

• Hand hygiene performed: [Yes / No] (If no, describe mitigation.)
• Skin preparation method: [Alcohol swab / Chlorhexidine / Other / Not captured]
• Single-use sterile needles utilized: [Yes / No] (If no, describe deviation and mitigation.)
• Clean field maintained: [Yes / No] (If no, describe deviation and mitigation.)
• Immediate sharps disposal into approved container: [Yes / No]

Equipment

• Needles: [Gauge/diameter] x [Length] (List ranges if multiple sizes used.)
• EA Stimulator: [Manufacturer and model]
• Channels used: [Number of channels]

Procedural Technique

Patient Position

[Position: supine / prone / side-lying / seated]. [Baseline symptom measure if assessed]

Point Selection

(List all points used with standard nomenclature. Include laterality and depth/technique notes for higher-risk regions. Add rows as needed.)

Point (standard code)	Laterality	Depth/Technique Notes	De qi
[Point code]	[Left / Right / Bilateral / Midline]	[Notes or "Not recorded"]	[Obtained / Not obtained / Not assessed]
[Point code]	[Left / Right / Bilateral / Midline]	[Notes or "Not recorded"]	[Obtained / Not obtained / Not assessed]

Electrical Stimulation Parameters

(Provide full channel mapping and settings. If the device does not display a parameter, document "Not recorded" rather than leaving blank. Do not simply document "EA performed" without parameter details. Add rows as needed.)

Channel #	Electrode A (point + laterality)	Electrode B (point + laterality)	Mode	Frequency (Hz)	Intensity	Pulse width	Polarity
[1]	[Point, Laterality]	[Point, Laterality]	[Continuous / Burst / Dense-disperse]	[Hz / Not recorded]	[mA or device units / Titrated to patient tolerance]	[ms / Not recorded]	[Setting / Not recorded]
[2]	[Point, Laterality]	[Point, Laterality]	[Continuous / Burst / Dense-disperse]	[Hz / Not recorded]	[mA or device units / Titrated to patient tolerance]	[ms / Not recorded]	[Setting / Not recorded]

Treatment Duration

• Electrical stimulation duration: [Start time – Stop time / Total minutes]
• Needle retention time: [Minutes / Same as stimulation duration / Not captured]
• Monitoring approach: [Continuous contact / Intermittent checks at specified interval]

Needle Count Verification

Needles inserted: [#] | Needles removed: [#] | All needles accounted for: [Yes / No]

(If count mismatch: document search performed, patient assessment, escalation, and resolution.)

Skin after removal: [Intact / Mild pinpoint bleeding / Bruising / Other]. Hemostasis: [Not needed / Pressure applied / Other]

Patient Response

[Tolerance: well tolerated / limited by discomfort or anxiety]. [Immediate response if assessed: change in pain score or symptom description]. [Patient-reported feedback]. (Distinguish immediate post-procedure response from expected durable benefit.)

Adverse Events

(Always complete this section. If none, document "None.")

[None / Event details: type (bleeding/bruising, increased soreness, dizziness/vasovagal, headache, skin irritation from clips/leads, other); timing (during / after procedure); severity (mild / moderate / severe); intervention performed; patient status at discharge; escalation or referral if required]

Aftercare and Follow-Up

• Condition at discharge: [Stable / Improved / Unchanged / Other]
• Aftercare instructions given: [Hydration, activity modification, expected soreness or bruising, other]
• Red flags reviewed: [Signs of infection, worsening pain, prolonged dizziness, unexpected numbness/weakness, skin burns or persistent irritation]
• Follow-up plan: [Next session timing, number of sessions planned if applicable, treatment goals]

(If any required information is not available, explicitly document "Not captured" rather than omitting or inferring.)