---
title: Care Plan Notes Template
description: "### Layout/Example Plan: 6 Month Corrective 24 Adjustments ($1565 Full Price) Start Date: 4/26/2023 - 1/24 Frequency: 2xw 4wks / 1xw 8wks / EOW 8wks Scans/X-Rays: 2 Scans 3 XRays (Cer LAT, Lum AP/LAT) Therapies: Back on Trac 12 Visits…"
url: "https://hillfamilychiropractic.com/wiki/care-plan-notes-template/"
updated: "2026-06-10"
category: Patient Care Procedures
---

# Care Plan Notes Template

### Layout/Example

Plan: 6 Month Corrective 24 Adjustments ($1565 Full Price)
 Start Date: 4/26/2023 - 1/24
 Frequency: 2xw 4wks / 1xw 8wks / EOW 8wks
 Scans/X-Rays: 2 Scans 3 XRays (Cer LAT, Lum AP/LAT)
 Therapies: Back on Trac 12 Visits ($605 Package Price)
 Full Price: Total Full Price $2107
 Discount Price: $1565 Add. Family Discount ($500)
 Payment Type: $260.83/month for 6 Months.
 Initials: -KMP

### Copy/Paste

** 💡 Copy and paste, then edit the list below to ensure not to miss anything in the patient care plan notes.**

Plan: # Adj: ($0 Full Price)
 Start Date:00/00/00 - 1/ Adj
 Frequency:x/W # Weeks / xW # Weeks
 Scans/ X-Rays:2 Scans # X-Rays (Cer AP/LAT, Tho AP/LAT, Lum AP/LAT)
 Therapies: # and location ($ Package Price) CP X-Rays: Ferg, C-Mold, L-Mold
 Full Price: $0 Total Full Price
 Discount Price: $0 First/Additional Family at a % discount ($ Care Plan Discount)
 Payment Type: $0.00/Month for # Months /Paid in Full
 Initials: -