Low Back Pain S/O Template

The tools below are provided to assist you in documentation and decision-making for LBP patients.
Edit the standard template to fit the needs of your current encounter.
Items on the right include CPGs, reference materials, and patient handouts.
Once your note is complete, click “select all” and copy/paste the text into the EHR.

Low Back Pain AP Helper
Low Back Pain

Red-Flag-Icon-PSDFor HEDIS metrics, be sure to add a diagnosis code if a red flag is marked.

  • Assess and document pain in accordance with local policy
  • Recommend a pain reassessment after any treatment/procedure and for a pain level over 6 or as per local policy
  • Consider referral to IBHC for additional assessment and non-pharmacological interventions for chronic pain management
Screening and Diagnosis
Initial Management and Screening

Initial Management

Blood Pressure Management
Follow Up Management Algorithm
LBP Physical Exam Scoring
Labs and Imaging

Labs and imaging studies are NOT indicated during the initial evaluation of patients with LBP UNLESS

  • Red Flags are present OR
  • SEVERE radicular or stenotic symptoms are present
LBP Diagnostic Chart

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