• Call: (844) 569-8628
  • |
  • Get a Quote
  • |
  • COVID-19 Updates
  • |
  • Log In
DrChrono gray logo
  • Solutions
    • Providers
    • EHR by Specialty
    • Telemedicine
    • Large Practice
    • Small Practice
    • Multi Specialty

    • Patients
    • Patient Portal - OnPatient

    • Partners & Affiliates
    • Become a Partner
    • API Developers
    • Affiliate Information
    • Apple Mobility Program
  • Platform
    • Product
    • Electronic Health Records
    • Telehealth
    • Practice Management
    • Medical Billing
    • Revenue Cycle Management
    • Patient Portal
    • Mobile EHR Solutions
    • App Marketplace

    • Features
    • All Features
    • Lab & Imaging
    • eRx & EPCS
    • Medical Templates
    • Feature videos
  • Resources
    • Resources & Tools
    • Resources
    • Case Studies
    • Blog
    • Specialties
    • Testimonials
    • Webinars
    • Plans
    • ONC Certification

    • Customer Help
    • Support Center
    • Training videos
  • Company
    • About Us
    • Blog
    • Diversity
    • Life & Culture
    • Press
  • Telehealth
  • Try Now
DrChrono gray logo mobile menu icon
Close out of menu icon
  • Solutions
    • Providers
    • EHR by Specialty
    • Telemedicine
    • Large Practice
    • Small Practice
    • Multi Specialty

    • Patients
    • Patient Portal - OnPatient

    • Partners & Affiliates
    • Become a Partner
    • API Developers
    • Affiliate Information
    • Apple Mobility Program
  • Platform
    • Product
    • Electronic Health Records
    • Telehealth
    • Practice Management
    • Medical Billing
    • Revenue Cycle Management
    • Patient Portal
    • Mobile EHR Solutions
    • App Marketplace

    • Features
    • All Features
    • Lab & Imaging
    • eRx & EPCS
    • Medical Templates
    • Feature videos
  • Resources
    • Resources & Tools
    • Resources
    • Case Studies
    • Blog
    • Specialties
    • Testimonials
    • Webinars
    • Plans
    • ONC Certification

    • Customer Help
    • Support Center
    • Training videos
  • Company
    • About Us
    • Blog
    • Diversity
    • Life & Culture
    • Press
  • Try Now Log In
DIAGNOSES
PROCEDURE MATERIALS
ICD-10 - MBB - Cervical - Required
Needle size and type
ICD-10 - MBB - Cervical
Prep Solution
MEDS - MISCELLANEOUS
Lidocane 1% volume - mL
MEDICATIONS - 4 LEVEL - BILATERAL - THERAPEUTIC
Bupivacaine 0.25% volume - mL - 4- Level - Bilateral
Dexamethasone (10mg/ml) volume - mL - 4- Level - Bilateral
MEDICATIONS - 3 LEVEL - BILATERAL - THERAPEUTIC
Bupivacaine 0.25% volume - mL - 3- Level - Bilateral
Dexamethasone (10mg/ml) volume - mL - 3 - Level - Bilateral
MEDICATIONS - 2 LEVEL - BILATERAL - THERAPEUTIC
Bupivacaine 0.25% volume - mL - 2- Level - Bilateral
Dexamethasone (10mg/ml) volume - mL - 2- Level - Bilateral
MEDICATIONS - 4 LEVEL - BILATERAL - DIAGNOSTIC
Bupivacaine 0.25% volume - mL - 4- Level - Bilateral - NO
MEDICATIONS - 3 LEVEL - BILATERAL - DIAGNOSTIC steroid
Bupivacaine 0.25% volume - mL - 3- Level - Bilateral - NO
MEDICATIONS - 2 LEVEL - BILATERAL - DIAGNOSTIC steroid
Bupivacaine 0.25% volume - mL - 2- Level - Bilateral - NO
MEDICATIONS - 4 LEVEL - LEFT - THERAPEUTIC
Bupivacaine 0.25% volume - mL - 4- Level - Left
Dexamethasone (10mg/ml) volume - mL - 4- Level - Left
MEDICATIONS - 3 LEVEL - LEFT - THERAPEUTIC
Bupivacaine 0.25% volume - mL - 3- Level - Left
Dexamethasone (10mg/ml) volume - mL - 3 - Level - Left
MEDICATIONS - 2 LEVEL - LEFT - THERAPEUTIC
Bupivacaine 0.25% volume - mL - 2- Level - Left
Dexamethasone (10mg/ml) volume - mL - 2- Level - Left
MEDICATIONS - 4 LEVEL - LEFT - DIAGNOSTIC
Bupivacaine 0.25% volume - mL - 4- Level - Left - NO
MEDICATIONS - 3 LEVEL - LEFT - DIAGNOSTIC
Bupivacaine 0.25% volume - mL - 3- Level - Left - NO
MEDICATIONS - 2 LEVEL - LEFT - DIAGNOSTIC
Bupivacaine 0.25% volume - mL - 2- Level - Left - NO
MEDICATIONS - 4 LEVEL - RIGHT - THERAPEUTIC
Bupivacaine 0.25% volume - mL - 4 - Level - Right
Dexamethasone (10mg/ml) volume - mL - 4- Level - Right
MEDICATIONS - 3 LEVEL - RIGHT - THERAPEUTIC
Bupivacaine 0.25% volume - mL - 3- Level - Right
Dexamethasone (10mg/ml) volume - mL - 3 - Level - Right
MEDICATIONS - 2 LEVEL - RIGHT - THERAPEUTIC
Bupivacaine 0.25% volume - mL - 2- Level - Right
Dexamethasone (10mg/ml) volume - mL - 2- Level - Right
MEDICATIONS - 4 LEVEL - RIGHT - DIAGNOSTIC
Bupivacaine 0.25% volume - mL - 4 - Level - Right - NO
MEDICATIONS - 3 LEVEL - RIGHT - DIAGNOSTIC
Bupivacaine 0.25% volume - mL - 3 - Level - Right - NO
MEDICATIONS - 2 LEVEL - RIGHT - DIAGNOSTIC
Bupivacaine 0.25% volume - mL - 2- Level - Right - NO
IMPORTANT HISTORY
RECOVERY ROOM
IMPORTANT HISTORY
RECOVERY
DIAGNOSTIC RESULTS
DIAGNOSTIC RESULTS
PROCEDURE
BILATERAL MBB
UNILATERAL MBB
DIAGNOSTIC - Bilateral
THERAPEUTIC - Bilateral
DIAGNOSTIC - Unilateral
THERAPEUTIC - Unilateral
4 LEVEL Bilateral - Therapeutic
3 LEVEL Bilateral - Therapeutic
2 LEVEL Bilateral - Therapeutic
4 LEVEL Bilateral - NO steroid
3 LEVEL Bilateral - NO steroid
2 LEVEL Bilateral - NO steroid
Bilateral C2, C3, C4, C5 - Therapeutic
Bilateral C3, C4, C5, C6 - Therapeutic
Bilateral C4, C5, C6, C7 - Therapeutic
Bilateral C5, C6, C7, C8 - Therapeutic
Bilateral C6, C7, C8, T1 - Therapeutic
Bilateral C7, C8, T1, T2 - Therapeutic
Bilateral C2, C3, C4, C5 - NO steroid
Bilateral C3, C4, C5, C6 - NO steroid
Bilateral C4, C5, C6, C7 - NO steroid
Bilateral C5, C6, C7, C8 - NO steroid
Bilateral C6, C7, C8, T1 - NO steroid
Bilateral C7, C8, T1, T2 - NO steroid
Bilateral C2, C3, C4 - Therapeutic
Bilateral C3, C4, C5 - Therapeutic
Bilateral C4, C5, C6 - Therapeutic
Bilateral C5, C6, C7 - Therapeutic
Bilateral C6, C7, C8 - Therapeutic
Bilateral C7, C8, T1 - Therapeutic
Bilateral C2, C3, C4 - NO steroid
Bilateral C3, C4, C5 - NO steroid
Bilateral C4, C5, C6 - NO steroid
Bilateral C5, C6, C7 - NO steroid
Bilateral C6, C7, C8 - NO steroid
Bilateral C7, C8, T1 - NO steroid
Bilateral C2, C3 - Therapeutic
Bilateral C3, C4 - Therapeutic
Bilateral C4, C5 - Therapeutic
Bilateral C5, C6 - Therapeutic
Bilateral C6, C7 - Therapeutic
Bilateral C7, C8 - Therapeutic
Bilateral C2, C3 - NO steroid
Bilateral C3, C4 - NO steroid
Bilateral C4, C5 - NO steroid
Bilateral C5, C6 - NO steroid
Bilateral C6, C7 - NO steroid
Bilateral C7, C8 - NO steroid
LEFT - Therapeutic
RIGHT - Therapeutic
LEFT - NO steroid
RIGHT - NO steroid
4 LEVEL Left - Therapeutic
3 LEVEL Left - Therapeutic
2 LEVEL Left - Therapeutic
4 LEVEL Right - Therapeutic
3 LEVEL Right - Therapeutic
2 LEVEL Right - Therapeutic
4 LEVEL Left - NO steroid
3 LEVEL Left - NO steroid
2 LEVEL Left - NO steroid
4 LEVEL Right - NO steroid
3 LEVEL Right - NO steroid
2 LEVEL Right - NO steroid
Left C2, C3, C4, C5 - Therapeutic
Left C3, C4, C5, C6 - Therapeutic
Left C4, C5, C6, C7 - Therapeutic
Left C5, C6, C7, C8 - Therapeutic
Left C6, C7, C8, T1 - Therapeutic
Left C7, C8, T1, T2 - Therapeutic
Right C2, C3, C4, C5 - Therapeutic
Right C3, C4, C5, C6 - Therapeutic
Right C4, C5, C6, C7 - Therapeutic
Right C5, C6, C7, C8 - Therapeutic
Right C6, C7, C8, T1 - Therapeutic
Right C7, C8, T1, T2 - Therapeutic
Left C2, C3, C4, C5 - NO steroid
Left C3, C4, C5, C6 - NO steroid
Left C4, C5, C6, C7 - NO steroid
Left C5, C6, C7, C8 - NO steroid
Left C6, C7, C8, T1 - NO steroid
Left C7, C8, T1, T2 - NO steroid
Right C2, C3, C4, C5 - NO steroid
Right C3, C4, C5, C6 - NO steroid
Right C4, C5, C6, C7 - NO steroid
Right C5, C6, C7, C8 - NO steroid
Right C6, C7, C8, T1 - NO steroid
Right C7, C8, T1, T2 - NO steroid
Left C2, C3, C4 - WITH steroid
Left C3, C4, C5 - WITH steroid
Left C4, C5, C6 - WITH steroid
Left C5, C6, C7 - WITH steroid
Left C6, C7, C8 - WITH steroid
Left C7, C8, T1 - WITH steroid
Right C2, C3, C4 - WITH steroid
Right C3, C4, C5 - WITH steroid
Right C4, C5, C6 - WITH steroid
Right C5, C6, C7 - WITH steroid
Right C6, C7, C8 - WITH steroid
Right C7, C8, T1 - WITH steroid
Left C2, C3, C4 - NO steroid
Left C3, C4, C5 - NO steroid
Left C4, C5, C6 - NO steroid
Left C5, C6, C7 - NO steroid
Left C6, C7, C8 - NO steroid
Left C7, C8, T1 - NO steroid
Right C2, C3, C4 - NO steroid
Right C3, C4, C5 - NO steroid
Right C4, C5, C6 - NO steroid
Right C5, C6, C7 - NO steroid
Right C6, C7, C8 - NO steroid
Right C7, C8, T1 - NO steroid
Left C2, C3 - WITH steroid
Left C3, C4 - WITH steroid
Left C4, C5 - WITH steroid
Left C5, C6 - WITH steroid
Left C6, C7 - WITH steroid
Left C7, C8 - WITH steroid
Right C2, C3 - WITH steroid
Right C3, C4 - WITH steroid
Right C4, C5 - WITH steroid
Right C5, C6 - WITH steroid
Right C6, C7 - WITH steroid
Right C7, C8 - WITH steroid
Left C2, C3 - NO steroid
Left C3, C4 - NO steroid
Left C4, C5 - NO steroid
Left C5, C6 - NO steroid
Left C6, C7 - NO steroid
Left C7, C8 - NO steroid
Right C2, C3 - NO steroid
Right C3, C4 - NO steroid
Right C4, C5 - NO steroid
Right C5, C6 - NO steroid
Right C6, C7 - NO steroid
Right C7, C8 - NO steroid
REPORT
Important History
Diagnosis
Diagnosis #1 - Required
Diagnosis #2
Bilateral C2, C3, C4, C5
Bilateral C2, C3, C4, C5
Bilateral C3, C4, C5, C6
Bilateral C3, C4, C5, C6
Bilateral C4, C5, C6, C7
Bilateral C4, C5, C6, C7
Bilateral C5, C6, C7, C8
Bilateral C5, C6, C7, C8
Bilateral C6, C7, C8, T1
Bilateral C6, C7, C8, T1
Bilateral C7, C8, T1, T2
Bilateral C7, C8, T1, T2
Bilateral C2, C3, C4
Bilateral C2, C3, C4
Bilateral C3, C4, C5
Bilateral C3, C4, C5
Bilateral C4, C5, C6
Bilateral C4, C5, C6
Bilateral C5, C6, C7
Bilateral C5, C6, C7
Bilateral C6, C7, C8
Bilateral C6, C7, C8
Bilateral C7, C8, T1
Bilateral C7, C8, T1
Bilateral C2, C3
Bilateral C2, C3
Bilateral C3, C4
Bilateral C3, C4
Bilateral C4, C5
Bilateral C4, C5
Bilateral C5, C6
Bilateral C5, C6
Bilateral C6, C7
Bilateral C6, C7
Bilateral C7, C8
Bilateral C7, C8
Left C2, C3, C4, C5
Right C2, C3, C4, C5
Left C3, C4, C5, C6
Right C3, C4, C5, C6
Left C4, C5, C6, C7
Right C4, C5, C6, C7
Left C5, C6, C7, C8
Right C5, C6, C7, C8
Left C6, C7, C8, T1
Right C6, C7, C8, T1
Left C7, C8, T1, T2
Right C7, C8, T1, T2
Left C2, C3, C4, C5
Right C2, C3, C4, C5
Left C3, C4, C5, C6
Right C3, C4, C5, C6
Left C4, C5, C6, C7
Right C4, C5, C6, C7
Left C5, C6, C7, C8
Right C5, C6, C7, C8
Left C6, C7, C8, T1
Right C6, C7, C8, T1
Left C7, C8, T1, T2
Right C7, C8, T1, T2
Left C2, C3, C4
Right C2, C3, C4
Left C3, C4, C5
Right C3, C4, C5
Left C4, C5, C6
Right C4, C5, C6
Left C5, C6, C7
Right C5, C6, C7
Left C6, C7, C8
Right C6, C7, C8
Left C7, C8, T1
Right C7, C8, T1
Left C2, C3, C4
Right C2, C3, C4
Left C3, C4, C5
Right C3, C4, C5
Left C4, C5, C6
Right C4, C5, C6
Left C5, C6, C7
Right C5, C6, C7
Left C6, C7, C8
Right C6, C7, C8
Left C7, C8, T1
Right C7, C8, T1
Left C2, C3
Right C2, C3
Left C3, C4
Right C3, C4
Left C4, C5
Right C4, C5
Left C5, C6
Right C5, C6
Left C6, C7
Right C6, C7
Left C7, C8
Right C7, C8
Left C2, C3
Right C2, C3
Left C3, C4
Right C3, C4
Left C4, C5
Right C4, C5
Left C5, C6
Right C5, C6
Left C6, C7
Right C6, C7
Left C7, C8
Right C7, C8
Op report 1
Bilateral C2, C3, C4, C5 - WITH
Bilateral C3, C4, C5, C6 - WITH
Bilateral C4, C5, C6, C7- WITH
Bilateral C5, C6, C7, C8 - WITH
Bilateral C6, C7, C8, T1 - WITH
Bilateral C7, C8, T1, T2 - WITH
Bilateral C2, C3, C4, C5 - NO
Bilateral C3, C4, C5, C6 - NO
Bilateral C4, C5, C6, C7- NO
Bilateral C5, C6, C7, C8 - NO
Bilateral C6, C7, C8, T1 - NO
Bilateral C7, C8, T1, T2 - NO
Bilateral C2, C3, C4 - WITH
Bilateral C3, C4, C5 - WITH
Bilateral C4, C5, C6 - WITH
Bilateral C5, C6, C7 - WITH
Bilateral C6, C7, C8 - WITH
Bilateral C7, C8, T1 - WITH
Bilateral C2, C3, C4 - NO
Bilateral C3, C4, C5 - NO
Bilateral C4, C5, C6 - NO
Bilateral C5, C6, C7 - NO
Bilateral C6, C7, C8 - NO
Bilateral C7, C8, T1 - NO
Bilateral C2, C3 - WITH
Bilateral C3, C4 - WITH
Bilateral C4, C5 - WITH
Bilateral C5, C6 - WITH
Bilateral C6, C7 - WITH
Bilateral C7, C8 - WITH
Bilateral C2, C3 - NO
Bilateral C3, C4 - NO
Bilateral C4, C5 - NO
Bilateral C5, C6 - NO
Bilateral C6, C7 - NO
Bilateral C7, C8 - NO
Left C2, C3, C4, C5 - WITH
Left C3, C4, C5, C6 - WITH
Left C4, C5, C6, C7 - WITH
Left C5, C6, C7, C8 - WITH
Left C6, C7, C8, T1 - WITH
Left C7, C8, T1, T2 - WITH
Right C2, C3, C4, C5 - WITH
Right C3, C4, C5, C6- WITH
Right C4, C5, C6, C7 - WITH
Right C5, C6, C7, C8 - WITH
Right C6, C7, C8, T1 - WITH
Right C7, C8, T1, T2 - WITH
Left C2, C3, C4, C5 - NO
Left C3, C4, C5, C6 - NO
Left C4, C5, C6, C7 - NO
Left C5, C6, C7, C8 - NO
Left C6, C7, C8, T1 - NO
Left C7, C8, T1, T2 - NO
Right C2, C3, C4, C5 - NO
Right C3, C4, C5, C6- NO
Right C4, C5, C6, C7 - NO
Right C5, C6, C7, C8 - NO
Right C6, C7, C8, T1 - NO
Right C7, C8, T1, T2 - NO
Left C2, C3, C4 - WITH
Left C3, C4, C5 - WITH
Left C4, C5, C6 - WITH
Left C5, C6, C7 - WITH
Left C6, C7, C8 - WITH
Left C7, C8, T1 - WITH
Right C2, C3, C4 - WITH
Right C3, C4, C5 - WITH
Right C4, C5, C6 - WITH
Right C5, C6, C7 - WITH
Right C6, C7, C8 - WITH
Right C7, C8, T1 - WITH
Left C2, C3, C4 - NO
Left C3, C4, C5 - NO
Left C4, C5, C6 - NO
Left C5, C6, C7 - NO
Left C6, C7, C8 - NO
Left C7, C8, T1 - NO
Right C2, C3, C4 - NO
Right C3, C4, C5 - NO
Right C4, C5, C6 - NO
Right C5, C6, C7 - NO
Right C6, C7, C8 - NO
Right C7, C8, T1 - NO
Left C2, C3 - WITH
Left C3, C4 - WITH
Left C4, C5 - WITH
Left C5, C6 - WITH
Left C6, C7 - WITH
Left C7, C8 - WITH
Right C2, C3 - WITH
Right C3, C4 - WITH
Right C4, C5 - WITH
Right C5, C6 - WITH
Right C6, C7 - WITH
Right C7, C8 - WITH
Left C2, C3 - NO
Left C3, C4 - NO
Left C4, C5 - NO
Left C5, C6 - NO
Left C6, C7 - NO
Left C7, C8 - NO
Right C2, C3 - NO
Right C3, C4 - NO
Right C4, C5 - NO
Right C5, C6 - NO
Right C6, C7 - NO
Right C7, C8 - NO
Op report 2 - Op details
Op report 3 - Normal Recovery
Procedure Materials
Prep Solution
Needle size and type
Lidocaine 1%
bupivacaine - Bilateral - 4 level WITH
dexamethasone - Bilateral - 4 level WITH
bupivacaine - Bilateral - 3 level WITH
dexamethasone - Bilateral - 3 level WITH
bupivacaine - Bilateral - 2 level WITH
dexamethasone - Bilateral - 2 level WITH
bupivacaine - Bilateral - 4 level NO
bupivacaine - Bilateral - 3 level NO
bupivacaine - Bilateral - 2 level NO
bupivacaine - Left - 4 level WITH
dexamethasone - Left - 4 level WITH
bupivacaine - Left - 3 level WITH
dexamethasone - Left - 3 level WITH
bupivacaine - Left - 2 level WITH
dexamethasone - Left - 2 level WITH
bupivacaine - Left - 4 level NO
bupivacaine - Left - 3 level NO
bupivacaine - Left - 2 level NO
bupivacaine - Right - 4 level WITH
dexamethasone - Right - 4 level WITH
bupivacaine - Right - 3 level WITH
dexamethasone - Right - 3 level WITH
bupivacaine - Right - 2 level WITH
dexamethasone - Right - 2 level WITH
bupivacaine - Right - 4 level NO
bupivacaine - Right - 3 level NO
bupivacaine - Right - 2 level NO
Recovery
Diagnostic results

MBB - Cervical Medical Form

Orthopedic Surgeon

Mark Test

There are 0 copies in use.
Published: Aug. 1, 2024, 4:03 p.m.
Doctor: Dr. History Physical
Rating: 0   /

Use this form Back to list

Download MBB - Cervical

If you have an account, log in to use or rate this form. Log In

Click to use an int'l or other #

Don't have an account? Sign up to use this form. Sign Up

Close
DrChrono white logo

328 Gibraltar Dr
Sunnyvale, CA 94089

Call us: (844) 569-8628

Apple app store logo
  • Free EHR Demo
  • EHR
  • Practice Management
  • Medical Billing
  • Revenue Cycle
    Management
  • Patient Portal
  • Mobile EHR
  • eRx
  • Plans
  • EHR Features
  • Lab & Imaging
  • Patient Education Materials
  • Universities & Schools
  • Security Policy
  • SSO Log In
  • EHR Checklist
  • Meaningful Use
  • EPCS
  • MACRA & MIPS
  • ICD-10 Info
  • Share your Experience
  • OnPatient Portal
  • OnPatient Terms of Use
  • OnPatient Privacy Policy
  • Security Policy
  • Support Center
  • Developer API & SDK
  • EHR FAQ
  • Medical Billing Calculator
  • Medical Form Library
  • Insurance Lookup
  • ICD & HCPCS Lookup
  • App Directory
  • About Us
  • News & Updates
  • Careers
  • Contact Us
  • Testimonials
  • Logos & Branding
  • Our Flickr
  • Press
© Copyright 2019 DrChrono Inc.
  • Privacy Policy
  • Terms of Use
  • Site Map
  • twitter icon
  • facebook icon
  • youtube icon