Reflexology Session Note (Oncology Supportive Care)

Date/Time: [session date; start and end time]

Patient: [name and identifiers per organization standard]

Provider: [name, credentials, certification if required]

Setting: [inpatient unit / infusion center / outpatient clinic / home / other]

Visit Type: [initial / follow-up]; [bedside / clinic]

Referral Source: [oncology referral / supportive care consult / RN request / self-request / not applicable]

Subjective

[Patient-reported reason for session and goals] (Summarize in 2–4 sentences using supportive-care language; include timing relative to cancer treatment or hospitalization when stated; include one brief direct quote if meaningful.)

Consent: [verbal / written / proxy / unable to consent] (If unable, document limitation and proxy source.)

Preferences: [foot vs hand preference; pressure preference; positioning tolerance; areas to avoid; touch sensitivities]

Baseline symptoms (patient-reported):

• Pain: [0–10 rating or descriptor]
• Anxiety/stress: [0–10 rating or descriptor]
• [Other relevant symptoms such as nausea, fatigue, neuropathy discomfort, sleep disturbance]: [rating or descriptor] (Include only if relevant to session goals.)

Oncology Safety Screen

• Chart review: [treatment phase; recent procedures; active precautions; relevant risk factors] (If not reviewed or unavailable, state explicitly.)
• Neuropathy/altered sensation: [location; severity; allodynia or numbness present / absent / not assessed]
• Skin integrity: [intact / wounds / bruising / radiation dermatitis / infection signs]
• Edema/lymphedema: [location and baseline swelling; compression garments in place / none / not applicable]
• Lines/devices: [type and location] (Note positioning accommodations to avoid traction or pressure.)

Safety summary: [safe to proceed as planned / modifications required] (List specific modifications. If stop/defer criteria triggered, document what occurred, actions taken, and who was notified.)

Objective

• General presentation: [alertness; distress level; ability to participate]
• Mobility: [ambulatory / assistive device / bedbound] (Include only if relevant.)
• Positioning: [supine / recliner / side-lying / seated]; [supports and limb elevation as applicable]
• Infection control: [standard / contact / neutropenic precautions followed] (Include only if applicable.)
• Vitals: [values] (Include only if required by policy or clinically relevant.)

Intervention

• Modality and duration: [feet / hands / both]; [total session time in minutes]
• Technique: [pressure level: very light / light]; [pacing: slow / moderate]; [anatomic regions addressed] (Use general terms; avoid organ-point claims.)
• Modifications applied: [adaptations for neuropathy, skin fragility, lines/devices, edema, fatigue, or positioning intolerance]
• Adjuncts: [guided breathing / relaxation cueing / grounding techniques / none]

Response

• Patient-reported outcomes: Pain [pre → post]; Anxiety [pre → post]; [other symptoms as relevant: pre → post] (Include brief quote if meaningful.)
• Observed response: [visible relaxation / slower breathing / reduced facial tension / fell asleep / other]
• Tolerance: [completed as planned / ended early with reason]
• Adverse events: [none observed or reported / event description with actions taken and notifications]

Plan

• Follow-up: [PRN / scheduled]; [anticipated frequency] (Omit if not applicable.)
• Next session focus: [target symptoms; planned modifications based on today's response] (Omit if not applicable.)
• Care team communication: [who contacted; reason; method; outcome] (Include only if communication occurred.)
• Patient education: [self-care techniques taught; safety advice provided] (Include only if education provided.)
• If deferred/canceled: [reason; who notified; rescheduling plan]

Signature: [provider name, credentials, date/time]

Addendum: [date/time; additional information] (Include only if needed; label clearly and do not overwrite original content.)