Improve the health of your patientswith meaningful information

• Easy to implement

• Cost-effective

• Time-efficient

• Insurance-friendly

FOR ADDITIONAL GROUP VISIT RESOURCES, VISIT LifestyleMatrix.comFOR ADDITIONAL GROUP VISIT RESOURCES, VISIT LifestyleMatrix.com

No Pain, Total Gain

GROUP VISIT TOOLKITGROUP VISIT TOOLKIT

LT-Guide-Healthy Weight GVT

This toolkit educates patients on the lifecycle of pain, where and how we feel pain, and why pain persists and doesn’t resolve for many. By exploring the underlying factors causing pain, patients will recognize patterns and long-term e�ects of unhealthy behaviors. Understanding the pitfalls of medication dependency and how poor nutrition, lack of exercise, high stress and inadequate sleep all contribute to poor healing and chronic pain, patients will embrace lifestyle choices that create lifelong, optimal health and chronic pain prevention. Use for patients with these issues:

THIS GROUP VISIT TOOLKIT INCLUDES:

© Living Wellness, LLC 2015. All rights reserved.

Visit Forms:Patient intake forms are designed to capturekey information to create e�cient, insurance-friendly patient encounters.

Patient Handout(s):Patient-friendly handout(s) assist you and improvethe implementation of key lifestyle tips necessaryto correct underlying causes of illness.

Multi-Media Education:Choose the best format to suit your presentation style• Video + audio version• Presentation slides for custom educationIdeal use for a Group Visit or one-on-one setting

Shilpa P. Saxena, MD is a Board-Certi�ed Family Practice physician whose passion and purpose come to life through sharing her innovative patient education and practice manage-ment solutions in her classic ‘keep it simple’ style. She serves as Faculty with the Institute for Functional Medicine, the Arizona Center for Integrative Medicine, the University of Miami, Miller School of Medicine, the Metabolic Medical Institute at George Washington University and most recently, joined the Lifestyle Matrix Resource Center serving as the Clinical Expert for the CM Vitals Program. Dr. Saxena is an expert in the Group Visit medical model, creator of Group Visit Toolkits, and co-author of The Ingredients Matter: India.

• Sciatica or leg pain• Low back pain• Neck or shoulder pain

• Headaches & migraines• Sports & accident-related

injuries• Tendonitis

• Autoimmune arthritis• Osteoarthritis• Fibromyalgia

Your patients want to change…now you have the toolsYour patients want to change…now you have the tools

Patient Name: Date of visit:

(initial) I understand as a participant in this Group Visit/Shared Medical Appointment, that I and other patients will discuss medical information in the presence of other patients, family members, staff, and the clinician. If I have medical concerns that are of a very private nature, I will request to discuss with the clinician in a private setting or will schedule an individual office visit. I will also respect the confidentiality of the other members of the group by not revealing medical, personal, or any other identifying information about others in attendance after the session is over.

CC: Pain Associated with Chronic Issue(s): 1. 2.

Location of Pain

Left, Right, Both

(circle all that apply)

Intensity(0=none;

10=horrible)

Better, Worse or Same

(in last 30 days)(circle all that

apply)

Better, Worse or Same

(in last 90 days)(circle all that

apply)

Things that make it better

(e.g. rest, moving, Rx, ice, etc.)

(to be completed by provider)

PHYSICAL EXAM(circle all that apply)

R-red; S-swollen; D-deformed; W-warm

Head L R B B W S B W S

Neck L R B B W S B W S

Shoulder(s) L R B B W S B W S

Elbow(s) L R B B W S B W S

Wrist(s) L R B B W S B W S

Hand(s) L R B B W S B W S

Back L R B B W S B W S

Hip(s) L R B B W S B W S

Knee(s) L R B B W S B W S

Ankle(s) L R B B W S B W S

Foot L R B B W S B W S

[ Insert Logo Here ] No Pain, Total Gain

© 2018 Living Wellness, LLC GVT-8 No Pain, Total Gain

Review of Systems (check all that apply):

Fatigue Malaise Unexplained Fevers Nausea Constipation Dizziness Weakness Rash Joint Swelling Joint Redness Joint Warmth

Past Medical History:

History of motor vehicle accident? Yes No If yes, how many?In general, do anti-inflammatories (e.g. aspirin and ibuprofen) make your pain better? Yes No More often than not, are narcotics (e.g. codeine) what you need to resolve pain? Yes No Depends

Family History (check all that apply in your family): Autoimmune disease (e.g. rheumatoid, lupus, psoriasis, ankylosing spondylitis, etc.) Gout Osteoarthritis (“old age” arthritis) Dependence/Addiction tendencies (e.g. smoking, alcohol, pain medications, illegal drugs of abuse)

SOAP Note

a Insurance-friendly

a Can be scanned into EMR

a Patient completes all

non-gray box sections

ASSESSMENT (to be completed by office):

Chronic pain syndrome Osteoarthritis: Knee Shoulder Spine (Lumb, Thor, Cerv) Other Autoimmune arthritis (specify) Other Overweight Obese BMI Other

PLAN OF CARE (to be completed by office):

Educated on pain physiology, impact of anti-inflammatory lifestyle signals to reduce pain syndromes and improve quality of life

Refill specified medications as previous: Follow-up for routine pain management appointment in/on PATIENT REQUESTS additional information on personalized anti-inflammatory lifestyle support for pain and/or

medication usage reduction.

Provider Signature/Date:

© 2018 Living Wellness, LLC GVT-8 No Pain, Total Gain

No Pain, Total Gain

Are you ready for a pain-free life?Register for our upcoming patient Group Visit:

Are you ready for a pain-free life?Register for our upcoming patient Group Visit:

Did you know that pain a�ects more Americans than diabetes, cancer and heart disease combined? Occasional aches and pains often turn into frequent pain, driving patients to turn to medications for relief. If the underlying factors contributing to chronic pain are never addressed, patients risk getting caught in the trap of pain pill dependency.

Join us to learn how to aviod getting trapped in a life of pain and understand the lifestyle factors that create lifelong, optimal health and prevent chronic pain.

Date/Time/Location

[ Insert Logo Here ]

Event Flyer

a Market to office patients

a Market to the greater

community

a Customizable

Word format

PowerPoint Slides

a Concepts reviewed in

video

a PPT slide files for

clinician to present

and modify as needed

a Handouts for patients

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name/logo

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My GoodNESS Self-Evaluation & Strategy

Mental

Common thoughtpatterns?

Too manyToo fastAll over the placeToo intenseConfused or slow

Emotional

Common types offeelings?

Worried or anxiousSad or blueMad or irritableJoyful or giddyPeaceful or content

Fulfilling relationships in my life??

FriendsFamilyPetsWork

Social

What gives sacrad meaning to my life?

God/spiritualityGratitudeService to others

Spiritual

Good

Nutrition

Up my waterStop sugary drinksLimit sweetsAvoid fake foodsUp the veggiesUp the fiber

Exercise

Move once hourlyWalk more oftenYoga or stretchingCore StrengtheningImprove postureStrength training

Meditate/prayBreathe (in 4, out 7)Avoid addictive sub-stances (e.g. alcohol, cigarettes, Rx/illegal drugs)

Stress Management

Avoid caffeine after lunchAvoid electronics & eating 3 hours before bedtimeCreate a bedtimeritual you love

Sleep

NESS

Other Beneficial Things I Am Learning Today That I Want To Implement:

The 3 C’s of Life: You must make the Choice to take the Chance if you want anything in life to Change.

Patient Name: Age: Date of visit:

Group Visit Presenter:

Please rate the value of today’s Group Visit (1=low/10=high): 1 2 3 4 5 6 7 8 9 10

What are the 3 most important things you learned or changes you plan to make from today’s Group Visit?

1.

2.

3.

Suggestions for Improvement:

Optional Testimonial:

We are seeking support to help other patients understand the benefits of the Group Visit model. Please tell us why you think other patients should attend a Group Visit.

(initial) I, give permission to (name of practice) to use my testimonial (using initials, age and hometown only) to help other patients understand the benefits of Group Visits and our practice.

[ Insert Logo Here ] No Pain, Total Gain Patient Feedback Form

Patient Feedback Form

a Patient feedback allows you to

improve your Group Visit

experience

a Collect Testimonials to help you

promote the Group Visit

experience with other patients

a Gives you important items the

patient plans to change so you

can hold them accountable

This toolkit educates patients on the lifecycle of pain, where and how we feel pain, and why pain persists and doesn’t resolve for many. By exploring the underlying factors causing pain, patients will recognize patterns and long-term e�ects of unhealthy behaviors. Understanding the pitfalls of medication dependency and how poor nutrition, lack of exercise, high stress and inadequate sleep all contribute to poor healing and chronic pain, patients will embrace lifestyle choices that create lifelong, optimal health and chronic pain prevention. Use for patients with these issues:

THIS GROUP VISIT TOOLKIT INCLUDES:

© Living Wellness, LLC 2015. All rights reserved.

Visit Forms:Patient intake forms are designed to capturekey information to create e�cient, insurance-friendly patient encounters.

Patient Handout(s):Patient-friendly handout(s) assist you and improvethe implementation of key lifestyle tips necessaryto correct underlying causes of illness.

Multi-Media Education:Choose the best format to suit your presentation style• Video + audio version• Presentation slides for custom educationIdeal use for a Group Visit or one-on-one setting

Shilpa P. Saxena, MD is a Board-Certi�ed Family Practice physician whose passion and purpose come to life through sharing her innovative patient education and practice manage-ment solutions in her classic ‘keep it simple’ style. She serves as Faculty with the Institute for Functional Medicine, the Arizona Center for Integrative Medicine, the University of Miami, Miller School of Medicine, the Metabolic Medical Institute at George Washington University and most recently, joined the Lifestyle Matrix Resource Center serving as the Clinical Expert for the CM Vitals Program. Dr. Saxena is an expert in the Group Visit medical model, creator of Group Visit Toolkits, and co-author of The Ingredients Matter: India.

• Sciatica or leg pain• Low back pain• Neck or shoulder pain

• Headaches & migraines• Sports & accident-related

injuries• Tendonitis

• Autoimmune arthritis• Osteoarthritis• Fibromyalgia

Your patients want to change…now you have the toolsYour patients want to change…now you have the tools

LT-GUIDE-MSKGVT-A