Aesthetics procedure note, botulinum toxin treatment
1Indication
- The areas to be treated and the patient's goal.
2Consent
- Risks, benefits, alternatives and the expected result discussed, with a cooling-off period where it applies.
- Written consent and photographs on the record.
3Procedure
- The product, its batch number and expiry, as recorded in the product log.
- The sites treated and the amount at each site, recorded in the treatment chart.
4Findings
- What was found or measured, in terms another clinician could act on.
5Complications
- Any complication, or a record that there were none.
- Anything that did not go to plan, and what was done about it.
6Aftercare and follow-up
- Aftercare advice given in writing.
- Review appointment arranged.
