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ANS Score Card

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CardioMetabolic Score:

HRV Total Power:

SDANN:

CAN Risk (Type):

Left Foot C-Fibers (Sweat Peak):

Right Foot C-Fibers (Sweat Peak):

Left Foot Microcirculation:

Right Foot Microcirculation:

Stress Index:

PTG Total Power (IR):

Endothelial Function Risk (Type):

CASP Risk (Type):

Left ABI:

Right ABI:

Body Fat Mass:

Body Mass Index (ratio):

Fitness Chart (Type):

LF/HF (Mental Stress) (ratio):

Notes:

Normal

Borderline

Abnormal

AUTONOMIC ASSESSMENT

Normal

Normal

Borderline

Borderline

Abnormal

Abnormal

Normal

Normal

Normal

Normal

Borderline

Borderline

Borderline

Borderline

Abnormal

Abnormal

Abnormal

Abnormal

VASCULAR ASSESSMENT

Normal

Normal

Normal

Normal

Normal

Normal

Borderline

Borderline

Borderline

Abnormal

Abnormal

Abnormal

Borderline

Borderline

Borderline

Abnormal

Abnormal

Abnormal

LIFESTYLE ASSESSMENT

Normal

Normal

Normal

Normal

Borderline

Borderline

Borderline

Borderline

Abnormal

Abnormal

Abnormal

Abnormal

Here is the "ANS Score Card"

Here you will upload the "Provider Report" results individually.

This helps the provider when going over results with the patient via. Telemedicine.

Scroll Down for more instructions.

Screen Shot 2019-08-31 at 12.45.51 PM.pn

Screen Shot 2019-08-31 at 12.45.51 PM.pn

Screen Shot 2019-08-31 at 12.45.51 PM.pn

Screen Shot 2019-08-31 at 12.45.51 PM.pn

Screen Shot 2019-08-31 at 12.45.51 PM.pn

Screen Shot 2019-08-31 at 12.45.51 PM.pn

Please scroll to bottom of page

Performed By: Ordered By:

REMEMBER

Always scroll to the bottom of the page and fill out the

"Performed by" & "Ordered by" section.

How to fill out ScoreCard