Examination of the Neuropathy Patient:

We urge you to perform a very thorough physical, neurologic and othopedic exam. BE SURE you are EM Compliant, and all of the required elements of a particular exam are included, ALWAYS INCLUDING upper and lower extremity DTRs, Motor, and Sensory Exams. Use of any classic physical medicine text is fine. At a minimum you also want to be performing vibratory sensation, and skin surface temps using a hand-held IR Thermometer. HANDS ON TRAINING in the ND Protocol is available by attending a Client Day or Clinic Day!

These are the very same findings you will repeat after the patients initial 5 weeks of care and at each re-evaluation. This VIDEO will help!
Should you find yourself deficient in these skill sets, consider attending the next ACOPM Neuropathy Summit.

Treatment Planning, Report of Findings and Case Presentation

The initial treatment plan is usually 3x/wk for 5 wks, followed by a re-evaluation. During this time the patient is always co-treating at home with their own NDGen Device and any applicable supplements and topicals. Typically, after 5 weeks, the patient is seen far less frequently, but at least monthly for 6-12 mos. Some patients improve MUCH more slowly, and require additional 5v week periods of in-office care as well as longer term care!
At the conclusion of the FIRST 5 Week initial clinic time, you as the clinician then assess if the patient has had a successful response. Dr. Hayes defines a successful outcome as at least a 20% improvement, based upon your initial intake parameters at the conclusion of the first 5 weeks.
*There are 3 required pieces of clinical co-treatment the patient needs at home from Day 1 of care: a. NDGen Estim Device b.  A copy of “Beating Neuropathy” (which they should already own from their initial analysis), and c. A Copy of “I Beat Neuropathy” which is designed to be a manual of patient recovery.
How Do I Price and Bill My Services? Billing Units Typically include EM Codes (exams initially and at 4-5 week intervals), and CPT Codes for Manual Therapies, Massage, Possibly NMR, Balance and Gait, Vestibular Retraining, etc. Other Unlisted Physical Medicine Procedures (97039 and 97139)  (Commonly Manual Rx Plus 2 Units Physical Medicine on each visit). Document carefully and ALWAYS be 100% Compliant!

You also have sales of supplements, NeuropathyDR Devices, and other products such as topicals and home care accessories. Reassure your staff and patients, and their families that 5 Weeks is the minimal time needed to assess response to the ND Protocol.

At home Co-Treatment is part of the ND Protocol. Each patient needs an NDGen device with a copy of  the book “I Beat Neuropathy” for the best chance of successful outcomes. Our experience tells us ownership is best, leading to better initial AND long term results, as well as better patient compliance and referrals.

EACH patient needs this neurostim portion of their recovery. At home neurostim nights, weekends and for breakthrough symptoms compliments the other key components of your in-office care.

*These items you need to be stocking in your clinic-plan ahead-lead time is 3-4 weeks on supply orders.

Some patients will require more than 5 weeks in the clinic, even with a device at home, which they typically will use twice daily, nights, weekends and for “breakthrough” symptoms.

Always remember: Patient outcomes are superior and your profit potential is very significant when patients are outfitted with their own stim units to use at home nights, weekends and for breakthrough Sx on the first day of treatment.


(These are samples of the in-office forms we use, some to keep track of a patient’s exam findings and treatment plan. These findings are then entered into EMR!
*These sample paper docs are for internal use and do not replace the need for EMR and great electronic records!)

SAMPLE Exam Sheet For You to Customize.doc

SAMPLE Case History for Charts For You To Customize .doc

Temperature Gradient Study Form.doc
(Thanks to Dr. Richard Merritt-refer to the video How to Use the IR Thermometer)

Quantitative Neuropathy Screening Examination.doc
(Thanks to Dr. Richard Merritt
-refer to the video How to Use the IR Thermometer)

Sample ND 1 Dr. Standalone Clinical Income/Expenses.pdf
Sample Layout Small Clinic ND 500 sqft office.pdf
Sample Patient Newsletter “Breakthroughs in Treating Neuropathy and Chronic Pain”
Sample Internal Treatment Room Charting for ND Patients

Case Presentation Sample Pricing and Report of Findings Videos

SAMPLE Initial NDNeuroStim Protocol Pricing Structure 032113.pdf

SAMPLEInitial NDPhotomedicine Protocol Pricing Structure 012813

ND Report Pre-Video


4. BE SURE to check for Drug/Nutrient Interactions before advising any dietary supplementation
You Can Get The Epocrates App HERE to Check Drug/Nutrient Interactions * It is known that Acetyl-L-Carnitine and CoQ10 CAN affect Thyroid Status and Thyroid Replacement Meds-Caution advised.
* It is known that Acetyl-L-Carnitine CAN affect Thyroid Status and Thyroid Replacement Meds-Caution advised. It is CONTRAINDICATED with concurrent chemotherapy, anti neoplastic and anti HIV drugs.
CoQ10 is CONTRAINDICATED in patients on Coumadin. NO Supplements Oral Or Topical should ever be administered to active or recovering patients with neoplasms, leukemia, etc WITHOUT written consent of the attending physicians and/or oncology team!

5. Many of your patients will be Diabetic, Morbidly Obese
and suffer from the devastating consequences of The Metabolic Syndrome. We urge you to appoint a staff person to be your patients’ Health Coach and that you establish a “Take Shape for Life” Weight Management Center* in your office after taking this Crucial Webinar
HERE After this 30 min Webinar, and if not already done, you may Enroll Your Practice HERE *This TSFL Program can help add a significant income stream to your practice too.

6. Regarding Typical Dietary Supplements
: Refer to ReadThisFirst.4.2.13

7. Devices and Supplies

You will need Copies of  Our Books to hand out as FREE Gifts and educate prospective patients and professionals, but especially for your Complimentary “Neuropathy Analyses”,  the point where all patients enter the ND Practice correctly… this is handled in Module 3, so you need to be ready.

Ordering Supplies and Equipment: DOWNLOAD The appropriate Order Form and follow the instructions In Your Members Forum


Protocol Selection In the Clinic- NDGen, LLLT/LED?

The Chart Below will help you decide.
Be Sure To Post your patient care questions and clinic stories in the Members Forum.
Download, Print and Laminate This Chart:
NeuropathyDR Clinical Protocol Flow Chart 2013.pdf

A. NDGen Family of NeuropathyDR Devices
Download, Print and Laminate This Chart:
Using The Ultima NEO for NDs 2.13

B. Watch These Introductory Videos:
Introduction to NDGen Device Family
Using the NDGen
NDGen Device Step by Step
NDGen Device Family for Hands
NDGen Device Family for Feet
C. Decide on best device for each individual patient and supply the most appropriate home care kit.
90% + of the time NDGen Devices will Serve Most Patients.
NDGen uses An Advanced FDA Approved multi-mode electrotherapy stimulator (Ultima Neo) that combines enhanced TENS, EMS, Interferential, and Microcurrent. It is dual channel device and includes the function of our most advanced TENS and EMS modes with body part diagrams, as well as an advanced Interferential device with sine wave technology, and a very state-of-the-art Microcurrent mode. Best of all, this electrotherapy unit operates on an ultra sleek, high capacity lithium ion battery which allows the user to use the Interferential function without being tethered to the wall, as well as long battery runs on the TENS/ EMS and Micro modes. A charging system and universal lead wires PLUS Your Choice of conductive socks or gloves are included!


D.  THOR – Photo Medicine LLLT/LE

Contact Us Directly Via Your Members Forum for Purchase and Training Click For More Info

E. Watch These Intro Videos:
Sample ND THOR Laser Application
THOR Laser LED Component
F. Once you have completed THOR Training, You will be granted access to the Special Physical Medicine Library. THOR Requires you have attended a Live Training Event within the past 36 Months. You’ll register by going to the special URL you will be supplied by the manufacturer.
Training VIDEOS apply to ReBuilder AND NDGen Protocols:
How to use IR Thermometer
Preparing Footbath And Checking Temps
Post Wet Method Foot Care
Using Gloves on Hands Wet
Snap Gloves Correctly
Using The Socks
Finally, We suggest that you download and listen to this audio:
Building an Enormous ND Practice with Dr. Merritt.mp3
Ordering Supplies and Equipment: DOWNLOAD The appropriate Order Form and follow the instructions In Your Members Forum
Very Specific Marketing For the ND practice will be handled in the next module.

Leave a Comment