Patient Treatment Plan
Injector SOAP Note
ZO Skincare Protocol
| Step | Product | Schedule | Dose | Why (Physiology) |
|---|
Copy this into Aesthetic Record and send to patient after consult.
THE GATE MAP — nothing advances until the row is complete
| To do this... | We must HAVE (all of it) | Who |
|---|---|---|
| Book the intro consult | ☐ Completed prescreen intake (signed, incl. comms consent) · ☐ Intro payment $197/$97 · ☐ State of residence = FL or AL ONLY (other states parked until licenses/DEA clear - decline politely + waitlist) · ☐ DOB / photo ID on file | VA |
| Order intro labs | ☐ Intake red-flag screen done (pregnancy/breastfeeding = stop) · ☐ Demographics into Fullscript · ☐ Fasting + draw-location instructions sent | VA |
| Hold the results/discovery call | ☐ All results in chart · ☐ Scorecard scored · ☐ Plan Builder draft generated · ☐ ONE lane picked by Dr. V | VA → DR |
| Enroll (any lane) | ☐ Payment IN FULL · ☐ Lane consents signed (tiers: BHRT/TRT consent + telehealth · concierge: Agreement + Hormone Addendum + Telehealth + Primary-Care + Application · peptide add-on: Acknowledgment) · ☐ Shipping address + preferred pharmacy | VA |
| Send first med order | ☐ Payment + consents verified in chart · ☐ Belmar profile created · ☐ Baseline symptom tracker sent · ☐ If testosterone: DEA active for patient state + PDMP checked + in-person requirement satisfied per state | VA → DR signs Rx |
| Refill / continue therapy | ☐ Required follow-up labs current (≤6 mo) · ☐ No unresolved safety flags · ☐ Service log current | VA checks → DR approves |
| Renew | ☐ New term payment in full · ☐ Renewal visit done · ☐ Updated consents if terms changed | VA |
Rule of thumb: form → payment → labs → call → consents+payment → meds. Money and signatures always land BEFORE the thing they unlock. If a row is incomplete, the answer is "as soon as we have your [missing item], we're ready."
Inquiry → send prescreen · VA
- Any inquiry (hormones, weight loss, peptides, "be my doctor") → send prescreen intake (Female Prescreen Reset / Male intake) + program info sheet.
- No booking until the form returns complete. Then book intro: $197 female / $97 male, paid at booking.
Intro labs — outside draw, zero clinic time · VA
- Order via Fullscript → Quest PSC (fasting AM). Female = 19-test panel (hormones, thyroid+TPO, ferritin/iron, B12, vit D 25-OH, metabolic). Male = T free/total, E2, thyroid, PSA, metabolic.
- Cortisol AM and reverse T3 are reflex adds only.
Score & review · VA then DR
- VA scores the Concierge Underwriting Scorecard (Consents tab has it). DR stages labs in the Plan Builder sub-tab.
- Pick ONE lane before the call: ≥7 green + 0 red → Concierge · confounders on labs → Foundation · hormone-deficient → Tier · any red flag → Tier/Foundation only.
Discovery/results call · DR
- Run the script in the Discovery Call sub-tab. One lane, one offer, close on the calendar.
Enroll · VA
- Consents per lane (Consents tab) → payment in full → Belmar order (formulary-only, 90-day fills) → symptom tracker sent.
Monitor & renew · VA + DR
- Recheck 6–8 wks after any start/change. Every touch = chart note + service-log line (powers refund math).
- Renewal task 45 days before term end. Cancellations: Payments tab has the refund calculator.
Hormone Tiers (1–3)
- ☐ Female: General Female BHRT Consent (estrogen / progesterone / testosterone / pellet risks)
- ☐ Male: Patient Packet & Consent — Male TRT Program
- ☐ Telehealth consent (remote visits)
- ☐ New Patient Registration & Consent
Files: Downloads/BHRT FORMS + Downloads/01 Patient-Facing
Concierge ($4,500/yr)
- ☐ Membership Agreement v2 (incl. refund fee schedule) — attorney-review draft
- ☐ Hormone Management Addendum
- ☐ Telehealth Consent + Consent for Primary Care
- ☐ Membership Application
Files: Desktop/TRT CLINIC/Concierge Medicine
Add-ons
- ☐ Peptide Therapy Acknowledgment (any peptide)
- ☐ GLP-1 program consent (weight-loss packet)
- ☐ Pellet procedure consent (in-office tier only)
Underwriting Scorecard (concierge)
Green (+1): age 30–55 · ≤2 stable conditions · ≤3 meds · metabolically stable · no controlled substances · no PCP / unhappy with access · thorough intake · wellness goals · self-employed or high-deductible · household potential.
Red (any one = no concierge): ≥5 meds · uncontrolled DM/CHF/CKD≥3b/active cancer · chronic pain / opioid-benzo · psych instability · demanding communication · expects insurance · ER-frequent · needs a specialist, not access.
Script generator — built around what THIS lead said
The 6 beats (20 minutes)
- 1. Verdict first (30 sec): "You were right — something IS off, and we found it. It's fixable. Can I walk you through it?"
- 2. One-thread story: findings as a single narrative (e.g., iron tank → thyroid conversion → the fatigue and hair), never a lab list.
- 3. The integrity move: "Anyone could sell you hormones off these labs. I won't — here's what you actually need." This is the strongest conversion line in the practice.
- 4. One offer, last sentence: the lane picked in review. Price lands as a footnote to a plan they already want.
- 5. Objections: "just supplements?" → correct dose/form/timing, verified by repeat labs — supervision IS the treatment · "my labs were normal" → normal range ≠ optimal (ferritin 16 "passes" a range that starts at 16) · "can't I start hormones now?" → "12 weeks from now we'll KNOW, not guess" · cost → "the expensive path is treating the wrong thing."
- 6. Close on the calendar: redraw booked + review visit booked + supplements ordered before hanging up. Text the plan summary same day.
Selling to women
They buy being taken seriously: validation, the comprehensive panel as proof, no-markup labs/meds as trust. Education converts — every abnormal is a visible plan line-item. Never rush the story.
Selling to men
They buy who they become: energy/drive, libido, strength, edge. Numbers close men — show the level, name the target. Frame as optimization, never illness. Give ONE clear recommendation.
Concierge pitch (score ≥7)
"You don't need my hormone program — you need a doctor. That's my concierge practice: $4,500 a year, everything I do, labs and meds at cost, capped at 25 patients." Mention founding perks while seats 1–10 last. If they hesitate → Foundation Reset $349 with $100 credit forward.
The insurance line
"A wellness doctor who costs less than your insurance premium — and actually answers." Follow with: "Keep a catastrophic plan for hospitals; use me for your actual health." Never say "instead of insurance."
UPGRADE PLAYS — converting existing patients between lanes
- Weight-loss patient → hormones (trigger: female 40+ on GLP-1, or plateau at week 8+): "There's a reason I check hormones on every weight patient — women on hormone therapy lose about 30% more on GLP-1s. Your labs suggest we're fighting with one hand tied. Want to look at both together?"
- Weight-loss / any patient → concierge (trigger: texts often, no PCP, asks about unrelated issues): "You keep needing a doctor, not a program. My concierge practice is exactly this — everything I do, $4,500 a year, capped at 25. You'd stop paying per-thing."
- Peptides → hormones (trigger: recovery/energy peptide patient 40+, results plateau): "Peptides work on top of your hormonal base — and yours has a gap. Fix the base and the peptides finally get traction. Let's run the panel."
- Hormone tier → concierge at renewal (trigger: low-touch, stable, term ending): "You barely needed me this term — that's exactly who my concierge seats are for. Same access to me, everything covered, meds at cost."
- Tier patient's spouse (trigger: any mention of partner symptoms): "That sounds exactly like what we just fixed for you. First consult for a spouse is on us if you join the membership — or he can start with the $97 intro."
- Aesthetics patient → wellness (trigger: tox/filler patient mentions fatigue/weight/sleep in the chair): "You know we do hormones and metabolic health too, right? Same philosophy as your skin plan — test, don't guess. It starts at $197 with full labs."
- Rules: upgrade talk happens at natural moments (results reviews, renewals, plateaus) — never cold. One upgrade suggestion per visit, max. Log every offer in the chart (huddle metric).
Lanes & pricing
- Intro consult + panel: $197 female / $97 male (all-inclusive, break-even by design)
- Foundation Reset: $349 / 12 weeks ($100 credits toward any lane within 6 months)
- Hormone Tiers: $1,850 (3-mo) · $3,300 (6-mo) · $6,000 (12-mo) — meds + monitoring labs included, visits 6-wk/3-mo/8-mo/12-mo
- Concierge: $4,500/yr upfront · 25 seats · founding perks seats 1–10 (rate-lock, 15% aesthetics, spouse consult)
- Add-ons monthly: GLP-1 sema $350 (member $295) · tirz $650 (member $575) · thyroid $85 · GSM $60 · metabolic reset $149 · PT-141 $150 · Wolverine $250 · NAD+ $300
- À-la-carte (non-member): visit $200 · lab review $150 · plan session $150
Rules: all packages/memberships paid in full upfront — no monthly billing anywhere. Meds/labs: tiers include them; concierge = patient-paid direct (hormones/thyroid at cost, GLP-1/peptides member pricing). Financing (Affirm/Klarna) may be offered on tiers ≥$1,850.
Concierge cancellation refund calculator
Add / update patient
Front-desk task queue (overdue red · next 14 days gold)
Wellness patients
STAFF — answer these (exact replies)
- "How much is it?" → "The first step is a $197 consult with Dr. Patel that includes a 40+ biomarker panel ($97 for men). Program pricing depends on what your labs show — Dr. Patel goes over it on your results call."
- "Does insurance cover it?" → "We're a cash practice — no insurance billing, which is how Dr. Patel keeps labs and medications at cost with no markup. Many patients use HSA/FSA."
- "What's included in the program?" → read from the Payments tab, never from memory.
- "Can I just get the labs?" → "The panel comes with the consult — the value is Dr. Patel's read of it. It's $197 all-in."
- "Do you prescribe Ozempic?" → "We offer physician-supervised GLP-1 programs — semaglutide and tirzepatide — after the intro consult clears you for it."
- "How fast can I be seen?" → book only AFTER prescreen form returns. "As soon as your intake is in, we'll get your labs ordered — most patients have results within a week."
- "Can I cancel / get a refund?" → "Programs are paid upfront; the membership has a written refund policy — Dr. Patel covers it before you sign anything."
- Refill requests → check chart for due labs first; if monitoring current, queue to Dr; if overdue: "Dr. Patel needs your follow-up labs before the next refill — here's the order."
STAFF — never answer (route to Dr. V)
- Any dosing, side-effect, or "is this normal?" question → "That's a clinical question — I'll have Dr. Patel address it; she answers within one business day."
- Lab interpretation of any kind.
- Whether a specific person is a candidate for any program.
- Discounts or price exceptions — none exist; founding perks are the only lever and they're defined.
- Anything about other patients. Anything legal/refund-dispute → Dr. V same day.
PROVIDER — clinical FAQ talk-tracks
- "Doesn't HRT cause breast cancer?" → "That fear comes from one 2002 study of oral synthetic hormones in women averaging 63. Estrogen-only users actually had LESS breast cancer. For women within 10 years of menopause using bioidentical, transdermal hormones, the risk picture is very different — and we screen and monitor either way."
- "Are bioidenticals FDA-approved?" → "The molecules are the same ones in FDA products; compounding lets me dose precisely and combine them. I'll always tell you when something is compounded vs branded, and you pay the pharmacy directly at cost."
- "Testosterone for women — is that safe?" → "It's the most abundant hormone in a woman's body and it's off-label because no company has run the approval trials — not because it's new. We dose to female physiologic levels and watch skin/hair at every visit."
- "Why cash / why so expensive?" → "I charge for my time and expertise only — your meds and labs are at my cost. Insurance medicine gives you 12 minutes; this is the opposite trade."
- "Can't my OB just do this?" → "If they will — wonderful, and I'll share the plan. Most weren't trained in this; it's a training gap, not a criticism."
- "Why not just give me hormones today?" → "Because your labs say the bottleneck is [X]. Twelve weeks from now we'll know instead of guess."
- "Pellets?" → "A great tool for the right patient — after we've found your dose on creams. I don't start anyone on a 3-month implant of an unknown dose."
PROVIDER — business FAQ
- "Monthly payments?" → "Programs are paid upfront — it keeps pricing honest and there's no rebilling ever. Financing (Affirm/Klarna) can split it on your side."
- "What if it doesn't work?" → "No one can guarantee outcomes and I won't. What I guarantee is the process: labs, adjustments, and my attention until we've genuinely tried."
- "Is the membership insurance?" → "No — keep a catastrophic plan for hospitals. This replaces the waiting room, not the ER."
- "Why is there a 25-patient cap?" → "Because unlimited access is only real if the panel is small. The cap is the product."
🧴 Skincare Follow-Up & Refill Queue
Every refill call is logged. Established patients: contact via AR ONLY — never GHL. (GHL is for new leads who never came in.)
1. THE CONCIERGE OFFER (assume gently): "Hi [name], it's [you] from Dr. V's! Your [product] usually runs out right about now, so I wanted to save you the trouble — want me to set your refill aside? I can use the card on file and text you when it's ready."
2. If they hesitate — the CARING WHY (educate, don't pressure): "Of course! The only reason I bring it up is that the home products are what carry your results between visits — Dr. V likes us to make sure nobody's progress stalls over a runout. Want me to hold one for you either way?"
3. If still unsure — the EASY OPTION (make it effortless): "Totally fine! And if coming in is the hassle, I can have it shipped straight to your door instead — same price, zero effort. Would that be easier?"
If it's a real no: "No problem at all — I'll check in with you at your next visit!" Then log it with what they said — the note is for us to serve them better next time, not to argue.
1. Phone charge + pickup: charge card on file → note to pull from shelf → text: "All set [name]! Your [product] is paid and waiting at the front desk — grab it any time this week 💛"
2. Ship to home (ZO site) — WE place the order, never the patient: get their card + shipping info on the phone, then YOU order at zoskinhealth.com/?practice-ref=2316470&practice-name=Dr+V+Medical+Aesthetics entering THEIR info as if they were ordering. Say: "I'll place it for you right now and it ships straight to your door." NEVER text the link and wait — a patient with a link to 'order later' never orders.
3. LAST RESORT — Clover invoice: send invoice → you must set a task to verify it was paid within 48h. Unpaid invoice = unfinished follow-up.
NO-ANSWER CADENCE (3 attempts max, alternate channels):
Attempt 1: CALL → no answer = voicemail + a short text same day. Log "No answer (retry)".
Attempt 2 (+2 days): TEXT with different wording — lead with the product: "Hi [name]! Your [product] refill is here with your name on it — want me to charge the card on file, or ship it to you?"
Attempt 3 (+5 more days): CALL one final time.
After 3: STOP — no more outreach (premium, not pestering). The queue flags them for an in-person close at their next visit and re-surfaces in 30 days.
⚠ Emergency Protocols
Tap a card to expand. Dr. V is not always on site. In every emergency: the NP on site takes over immediately — if NO provider is on site, call 911. Then CALL DR. V right away, every time — she directs care by phone. You will never be in trouble for calling 911 or calling Dr. V "too soon." Over-calling is always the right call.
🩸 VASCULAR OCCLUSION (filler) — minutes matter
Recognize: blanching (white/dusky skin) · severe pain out of proportion · mottled/livedo pattern · delayed cap refill · (late: dusky purple, coolness)
DO NOW: 1) STOP injecting · 2) Get the NP into the room immediately (no provider on site = call 911) · 3) CALL DR. V NOW — she directs treatment by phone if she's not on site · 4) Grab the BLACK BOX VO KIT + HYLENEX from the FRIDGE · 5) Warm compress on the area · 6) NP floods area with hyaluronidase (high-dose pulse, repeat until reperfusion) · 7) Massage area · 8) Reassess cap refill every few minutes
ANY vision change/eye pain = 911 + tell them "possible retinal artery occlusion from facial filler" — minutes matter for sight.
Document: time of onset, signs, hyaluronidase doses+times+lot, response, photos, all provider communications, patient instructions given. Do not discharge until provider clears; arrange next-day follow-up.
😵 PATIENT PASSING OUT (vasovagal / syncope)
Recognize: pale, sweaty, "I feel weird/hot," tunnel vision, slow pulse — most common right after needles.
DO NOW: 1) Stop procedure, protect from falling · 2) Lay flat, LEGS UP · 3) Cold compress to neck/forehead · 4) Call provider in · 5) Vitals when able · 6) Small sips of juice/water when fully alert · 7) Recover 15+ min, no driving until fully normal
Unresponsive >1 minute, chest pain, irregular breathing, or seizure activity = 911.
Document: time down/up, vitals, recovery, provider assessment. Flag chart "vasovagal hx — premedicate with recline + distraction next visit."
🤧 ANAPHYLAXIS / SEVERE ALLERGIC REACTION
Recognize: hives spreading · face/lip/throat swelling · wheeze/trouble breathing · dizziness/collapse — usually within minutes of product.
DO NOW: 1) CALL 911 · 2) NP administers EPINEPHRINE — it's INSIDE the BLACK BOX VO KIT (if no provider on site, tell the 911 dispatcher you have epinephrine on hand and follow their instructions) · 3) Lay flat, legs raised (sitting up if breathing is hard) · 4) Second epi in 5-15 min if no improvement · 5) Nothing by mouth · 6) Stay with patient, note times · 7) CALL DR. V — immediately, phone is fine
After: ER transport even if improved (biphasic reactions). Document product/lot, timeline, doses, EMS handoff.
Mild allergic (localized hives/itch, NO breathing/face involvement): provider assesses → antihistamine per provider order → observe 30+ min → document.
🔴 NODULES & GRANULOMAS (days-to-months later)
FD — patient calls about a lump: never dismiss it, never diagnose it. Ask: When did it appear? Which treatment/filler? Painful? Red/warm? Fever? Growing? Then notify the provider SAME DAY and log the call verbatim in AR. Your only job is triage + booking — the clinical part below is for the NP + Dr. V.
Say: "I'm so glad you called — this is something our provider will want to look at directly. Let me get you in [this week]."
RED FLAGS → same-week visit + Dr. V notified immediately (phone OK): red + warm + painful · fever · rapidly growing · skin breakdown
NP — classify first (the timeline tells you the cause):
① Early, NOT inflamed (weeks 1–4): usually superficial placement, maldistribution, or product clumping — a placement problem, not an immune problem. → Vigorous massage first; if it persists: saline or lidocaine displacement, or needle subcision to break it up.
② HA filler + INFLAMED (red/warm/painful, any timing): treat as immune reaction or biofilm. → High-dose PULSE hyaluronidase (Hylenex — fridge), repeated until full resolution · add doxycycline if biofilm is suspected.
③ Delayed 3+ months / biostimulators (Sculptra, Radiesse): true granuloma — foreign-body immune reaction or biofilm; hyaluronidase won't dissolve these products. → Intralesional 5-FU combined with LOW-dose corticosteroid (triamcinolone or dexamethasone) — the combo suppresses the fibroblast overgrowth without causing skin atrophy · oral support per Dr. V · refractory cases: refer for ultrasound-guided precision injection.
Every case: Dr. V is looped in before treatment — phone is fine. Document filler type + lot if known, onset timeline, inflammatory signs, classification, treatment + doses, photos.
🔥 BURNS (laser / IPL / RF / peels)
Recognize: immediate excessive pain, white/grey patches, blistering, epidermal sliding during or after energy treatment.
DO NOW: 1) Stop treatment · 2) Cool (not ice) compresses / cool saline 10-15 min · 3) Provider assesses depth · 4) Per provider: topical care, dressing, possible Rx · 5) Photos NOW (documentation + monitoring baseline)
After: written aftercare (no picking, strict SPF, signs of infection) · 24-48h follow-up call SCHEDULED before they leave · PIH protocol applies to healing (see Training tab) · document settings used, area, immediate response, all care given.
💊 MINOR REACTIONS (expected vs. concerning)
Normal & expected (reassure + monitor): bruising, mild swelling, tenderness, pinpoint bleeding, redness 24-48h post-MN/laser, mild headache post-tox, small lumps that settle ~2 weeks post-filler.
Concerning → provider TODAY: worsening after day 3 · spreading redness/warmth (infection) · fever · severe/one-sided swelling · dusky color change · vision anything · blistering/cold sores post-lip work.
FD rule: NEVER say "that's normal" — say: "Thanks for telling us — I'm flagging this to the provider who treated you and they'll follow up shortly." Then actually flag it, same hour, and log it in AR.
📞 AFTER ANY EVENT — the follow-up loop
1) Chart everything same day (times, meds+lots, response, photos, instructions)
2) Add the patient to next week's FOLLOW-UP LIST on the huddle with a note of what happened — they get a personal reassurance call, not the standard script
3) Dr. V reviews every event at the weekly huddle build
4) Do NOT ask an event patient for a Google review — the follow-up call is about care, full stop.
Black Box VO Kit + Hylenex (fridge) locations: confirm at every Thursday huddle — it's on the closeout. Remember: Dr. V is called IMMEDIATELY in every event, even by phone — never wait for her to be on site.
🎓 Staff Training Library
Tap any document to open it. New patient-safety and sales protocols are added here — check back after huddle updates.
More sections coming — tell Dr. V what you want trained on next.
🧬 Skin of Color Risk Assessment
Fitzpatrick + Roberts H (hyperpigmentation) + Roberts S (scarring) → risk profile + ZO conditioning + copy-paste chart note. Provider use only · Dr. V Aesthetics protocol. Answer every question; scores update live.
H0 hypopigmentation · H1 minimal & transient (<1 yr) · H2 minimal & permanent · H3 moderate & transient · H4 moderate & permanent · H5 severe & transient · H6 severe & permanent. H0–1: standard planning · H2: pre-condition before energy devices · H3–4: mandatory extended prep, treat as one FP higher, conservative settings · H5–6: highest PIH risk — Dr. V review before ANY controlled-injury treatment; test spot mandatory.
S0 atrophy · S1 none · S2 macule (flat mark) · S3 plaque, within wound margins (hypertrophic) · S4 keloid · S5 keloidal nodule. S4+ = RED FLAG: keloid anywhere = keloid tendency everywhere. Provider review before ANY controlled-injury treatment; topical-first approach; keloid risk in consent.
| Profile | Prep window | Settings | Test spot |
|---|---|---|---|
| LOW (FP I–II, H0–1, S0–2) | None required · SPF baseline | Standard | Optional |
| MODERATE (FP III or H2) | 2–4 wks ZO conditioning | Standard, monitor endpoints closely | Recommended |
| HIGH (FP IV–V, or H3–4, or S3) | 4–6 wks (6–8 if prior PIH) | Conservative — treat as one FP higher · longer intervals | MANDATORY |
| VERY HIGH (FP VI, or H5–6, or S4+) | 6–8 wks + Dr. V eval | Dr. V approves plan · lowest effective settings · consider topical-only | MANDATORY + 2-wk read |
| H score | ZO melanin suppressant | Retinoid | Oral adjuncts (Dr. V order) |
|---|---|---|---|
| H0–1 | Daily Power Defense + SPF 50 daily | Retinol 0.25–0.5% nightly as tolerated | None |
| H2 | Pigment Control Program (non-HQ brighteners) + SPF 50 | Retinol 0.5% nightly, 2–3 wks before treatment | None routinely |
| H3 | Pigment Control + 4% HQ kit ×4–6 wks pre-treatment | Retinol 0.5–1% or Rx tretinoin per Dr. V | Consider tranexamic acid per Dr. V |
| H4+ | 4% HQ kit ×6–8 wks + strict SPF; hold HQ 5 days pre-procedure | Rx tretinoin per Dr. V; stop 5–7 days pre-procedure | Tranexamic acid / other — Dr. V evaluates |
🔐 Team Vault
Logins are encrypted in the browser with your master passphrase (AES-256) before anything is saved — the sheet only ever stores scrambled text. If the passphrase is forgotten, the vault CANNOT be recovered. Auto-locks after 5 minutes idle.
First time? The passphrase you enter now becomes the vault's passphrase.