Hubbard Tank Hydrotherapy Treatment Note

Date of service: [Date of service]

Patient: [Patient name and identifiers]

Clinician: [Clinician name and credentials]

Primary diagnosis: [Diagnosis and ICD-10 code]

Precautions: [Relevant precautions] (Include only precautions pertinent to today's session; omit line if none.)

Indication & Medical Necessity

[Clinical indication and functional goal for Hubbard tank hydrotherapy] (Write 2–4 sentences linking the modality to specific functional goals. State why skilled clinician expertise is required for parameter selection, monitoring, and integration with the treatment plan.)

Pre-Treatment Assessment

Contraindications reviewed: [Screening status and findings] (Confirm screening for fever, cardiovascular instability, incontinence, bleeding risk, seizure risk, impaired sensation/communication; note any positives or inability to assess.)

Baseline pain: [Rating on consistent scale] at [location]

Skin status: [Location and pre-immersion appearance of wounds/fragile skin] (Include only if skin integrity is a concern; omit line if not applicable.)

Transfer/assist level: [Required assistance and equipment for safe entry/exit]

Baseline vitals: [Relevant vitals] (Include only when clinically indicated; omit if not indicated.)

Treatment Parameters

Water temperature: [Temperature with units]

Immersion time: [Start–stop times or total minutes]

Body regions treated: [Specific regions immersed]

Positioning: [Patient position and supports used]

Agitation/jet setting: [Setting level and targeted locations]

Additives: [Agent and purpose] (Omit line if none used.)

Wound protection: [Barrier method used] (Omit line if no wounds.)

Monitoring & Response

Intra-session observations: [Symptoms, physiologic changes, parameter adjustments, clinician actions]

Post-treatment pain: [Rating on same scale as baseline] at [location]

Objective response: [Changes relevant to session goals] (Note ROM tolerance, guarding, edema, soft-tissue extensibility, or functional tolerance as applicable.)

Skin reassessment: [Post-immersion skin findings] (Include only if skin integrity is relevant; omit line if not applicable.)

Tolerance and interpretation: [Specific tolerance statement] (Address endurance, hemodynamic stability, thermoregulation; avoid generic "tolerated well.") Session goals: [met / partially met / not met] with brief rationale.

Additional Interventions

(Omit this entire section if Hubbard tank was the only service provided.)

• [Intervention name]: [Goal]. [Dosage/method]. [Patient response].

(Add additional interventions as needed using same format.)

Time & Billing Summary

Total treatment time: [Total session minutes including Hubbard tank]

Total timed-code minutes: [Minutes for timed services only, excluding 97022]

Hubbard tank (97022): Untimed modality, 1 unit

• [Timed CPT code and description] — [Minutes]

(List each timed code with minutes. Note any non-billable time such as rest breaks if relevant.)

Plan

• [Parameter adjustments for next session]
• [Progression goals and criteria for advancement]
• [Coordination needs] (Omit if none.)

Clinician signature: [Name, credentials] — [Date/time]

Assistant involvement: [Contributors and supervising clinician] (Include only if applicable per facility policy.)