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501 North Frederick Avenue Suite 302 Gaithersburg, MD 20877Tel 301.591.8261 Fax 301.591.8262 www.painspineandrehab.comDIAGNOSTIC MEDIAL BRANCH BLOCK EVALUATION SHEET Patients Name ___ Dr. Sheikh ___Office

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What is diagnostic medial branch block?

Diagnostic medial branch block is a procedure used to identify the source of pain in the spine.

Who is required to file diagnostic medial branch block?

Medical professionals such as pain management specialists or anesthesiologists are required to perform and file diagnostic medial branch block.

How to fill out diagnostic medial branch block?

The diagnostic medial branch block form must be filled out with detailed information about the patient, the procedure, and any observations or findings.

What is the purpose of diagnostic medial branch block?

The purpose of diagnostic medial branch block is to determine if a specific branch of nerves is causing a patient's pain.

What information must be reported on diagnostic medial branch block?

The report must include the patient's information, the procedure details, any medications used, the results of the block, and any follow-up recommendations.

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