# TMS Treatment Session Log

| Form ID | FRM-TMS-001 | Revision | 1.0 |
|---------|-------------|----------|-----|

---

## Patient Information

| Field | Entry |
|-------|-------|
| Patient Name | |
| MRN | |
| Date of Birth | |
| Diagnosis | ☐ MDD ☐ OCD ☐ Other: _______ |
| Treatment Protocol | ☐ Standard rTMS ☐ iTBS ☐ Other: _______ |
| Prescribing Physician | |

---

## Session Information

| Field | Entry |
|-------|-------|
| Date | |
| Session Number | ____ of ____ |
| Start Time | |
| End Time | |
| Operator Name | |
| Operator Credentials | |

---

## Pre-Treatment Assessment

### Daily Safety Screening

| Question | Response |
|----------|----------|
| Any new medications since last session? | ☐ Yes (list below) ☐ No |
| Any changes to existing medications? | ☐ Yes (list below) ☐ No |
| Did you get at least 4 hours of sleep? | ☐ Yes ☐ No |
| Any alcohol in past 24 hours? | ☐ Yes (amount: _____) ☐ No |
| Any recreational drugs? | ☐ Yes ☐ No |
| Any new medical symptoms or illness? | ☐ Yes (describe below) ☐ No |
| Any problems since last treatment? | ☐ Yes (describe below) ☐ No |

**Notes on positive responses:**

---

### Vital Signs (if indicated)

| Parameter | Value |
|-----------|-------|
| Blood Pressure | / mmHg |
| Heart Rate | bpm |

---

## Treatment Parameters

### Motor Threshold

| Field | Entry |
|-------|-------|
| Motor Threshold (%) | |
| MT Determination Date | |
| Rechecked This Session? | ☐ Yes ☐ No |

### Stimulation Parameters

| Parameter | Prescribed | Delivered |
|-----------|------------|-----------|
| Target Site | | |
| Coil Type | | |
| Frequency (Hz) | | |
| Intensity (% MT) | | |
| Pulses per Train | | |
| Inter-Train Interval (sec) | | |
| Number of Trains | | |
| Total Pulses | | |
| Session Duration | | |

### Coil Position

| Field | Entry |
|-------|-------|
| Positioning Method | ☐ 5-cm Rule ☐ Neuronavigation ☐ Other |
| Coil Position Verified? | ☐ Yes |
| Coil Angle | |
| Position Markings Used? | ☐ Yes ☐ No |

---

## Treatment Delivery

| Field | Entry |
|-------|-------|
| Full Treatment Delivered? | ☐ Yes ☐ No |
| If No, Reason | |
| If No, Pulses Delivered | |

### Interruptions (if any)

| Time | Duration | Reason |
|------|----------|--------|
| | | |
| | | |

---

## Patient Tolerance

### During Treatment

| Symptom | Present? | Severity (1-10) | Notes |
|---------|----------|-----------------|-------|
| Scalp pain/discomfort | ☐ Yes ☐ No | | |
| Facial twitching | ☐ Yes ☐ No | | |
| Neck pain | ☐ Yes ☐ No | | |
| Dizziness/lightheadedness | ☐ Yes ☐ No | | |
| Anxiety | ☐ Yes ☐ No | | |
| Other: | ☐ Yes ☐ No | | |

**Comfort Measures Used:**
☐ Repositioning  ☐ Intensity adjustment  ☐ Break taken  ☐ Other: _______

### Post-Treatment Assessment

| Symptom | Present? | Severity (1-10) |
|---------|----------|-----------------|
| Headache | ☐ Yes ☐ No | |
| Scalp tenderness | ☐ Yes ☐ No | |
| Fatigue | ☐ Yes ☐ No | |
| Difficulty concentrating | ☐ Yes ☐ No | |
| Other: | ☐ Yes ☐ No | |

### Overall Tolerance Rating

☐ Excellent - No discomfort
☐ Good - Mild, tolerable discomfort
☐ Fair - Moderate discomfort requiring intervention
☐ Poor - Significant discomfort, treatment modified
☐ Intolerable - Treatment stopped early

---

## Adverse Events

☐ No adverse events this session

| Event | Details |
|-------|---------|
| Description | |
| Time of Onset | |
| Duration | |
| Severity | ☐ Mild ☐ Moderate ☐ Severe |
| Action Taken | |
| Resolved? | ☐ Yes ☐ No ☐ Ongoing |
| Physician Notified? | ☐ Yes ☐ No ☐ N/A |
| Physician Name/Time | |

**Adverse Event Report Filed?** ☐ Yes (Report #: _____) ☐ No ☐ N/A

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## Clinical Observations

**Patient's subjective report of symptom change:**
☐ Much worse  ☐ Somewhat worse  ☐ No change  ☐ Somewhat better  ☐ Much better

**Comments:**

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## Weekly Outcome Assessment (if applicable)

| Assessment | Score | Date |
|------------|-------|------|
| PHQ-9 | | |
| HAM-D | | |
| Y-BOCS | | |
| Other: | | |

---

## Equipment

| Field | Entry |
|-------|-------|
| Device Model/Serial # | |
| Coil Serial # | |
| Equipment Functioning Normally? | ☐ Yes ☐ No |
| Issues Noted | |

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## Next Session

| Field | Entry |
|-------|-------|
| Next Appointment Date | |
| Next Appointment Time | |
| Parameters to Modify? | ☐ Yes (describe) ☐ No |
| MT Recheck Needed? | ☐ Yes ☐ No |
| Physician Review Needed? | ☐ Yes ☐ No |

---

## Signatures

### Operator Attestation

I certify that this treatment session was administered in accordance with the prescribed protocol and documented accurately.

| Field | Entry |
|-------|-------|
| Operator Signature | |
| Date | |
| Time | |

### Supervising Physician Review (if required)

| Field | Entry |
|-------|-------|
| Physician Signature | |
| Date | |
| Comments | |

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*Form FRM-TMS-001 Rev 1.0 - TMS Treatment Session Log*