Pre-Chart: HIV

HIV Clinic Pre-Charting Template with Evidence-Based Medicine Integration

Patient Information:

Name: [text]
Date of Birth: [date]
Medical Record Number (MRN): [text]
Date of Visit: [date default="today"]
Reason for Visit:

[select value="Follow-up|New Patient|Medication Refill|Other"]
[text name="other_reason" memo="If 'Other', please specify"]
History (To be completed during patient interview):

ID:

Name: [text]
Age: [text]
Sex: [radio value="Male|Female|Other"]
Marital Status: [text]
Race: [text]
CC:

[comment memo_color="orange" memo="Document patient's primary reason for visit here."]
HPI:

[comment memo_color="orange" memo="Gather details about the onset, duration, and severity of symptoms. Include any relevant precipitating events."]
[comment memo_color="lightgreen" memo="Inquire about HIV risk factors and sexual history. Discuss PrEP/PEP if applicable."]
Medications:

[comment memo_color="orange" memo="List all current medications, including HIV regimen and adherence information."]
[comment memo_color="red" memo="Note any allergies and adverse reactions to medications."]
PMH:

[comment memo_color="orange" memo="Document relevant medical history, including surgeries, hospitalizations, and vaccinations."]
Allergies:

[comment memo_color="red" memo="List medication allergies and any associated reactions."]
FH:

[comment memo_color="orange" memo="Inquire about family history of relevant medical conditions."]
Social History:

[comment memo_color="orange" memo="Gather information about smoking, alcohol use, drug use, sexual history, living situation, and support system."]
Review of Systems (ROS):

[comment memo_color="orange" memo="Perform a thorough review of systems to identify any new or ongoing issues."]
Ob-Gyn Hx (if applicable):

[comment memo_color="orange" memo="Obtain relevant obstetric and gynecologic history for female patients."]
Additional Notes:

[textarea memo="Use this space to document any additional information or questions to address during the patient interview."]
Evidence-Based Medicine Considerations (For Reference):

Adherence: Prioritize adherence assessment and support.
Smoking Cessation: Encourage and support smoking cessation.
Alcohol and Drug Use: Screen for harmful use and provide appropriate interventions.
PrEP/PEP: Offer PrEP or PEP when indicated.
Cardiovascular Risk: Assess and manage cardiovascular risk factors.
Opportunistic Infections: Follow guidelines for prophylaxis.
Instructions for Use:

Before the Visit: Complete the patient information and reason for visit sections.
During the Visit: Utilize the pre-charting template as a guide during the patient interview, filling in the relevant sections as you gather information.
Post-Visit: Review and complete any remaining sections, ensuring a comprehensive and accurate medical record.
This pre-charting template serves as a structured tool to streamline the patient interview process, facilitate evidence-based decision-making, and ensure comprehensive data collection for optimal HIV care.
HIV Clinic Pre-Charting Template with Evidence-Based Medicine Integration

Patient Information:

Name:
Date of Birth:
Medical Record Number (MRN):
Date of Visit:
Reason for Visit:


If 'Other', please specify
History (To be completed during patient interview):

ID:

Name:
Age:
Sex:
Marital Status:
Race:
CC:

Document patient's primary reason for visit here.
HPI:

Gather details about the onset, duration, and severity of symptoms. Include any relevant precipitating events.
Inquire about HIV risk factors and sexual history. Discuss PrEP/PEP if applicable.
Medications:

List all current medications, including HIV regimen and adherence information.
Note any allergies and adverse reactions to medications.
PMH:

Document relevant medical history, including surgeries, hospitalizations, and vaccinations.
Allergies:

List medication allergies and any associated reactions.
FH:

Inquire about family history of relevant medical conditions.
Social History:

Gather information about smoking, alcohol use, drug use, sexual history, living situation, and support system.
Review of Systems (ROS):

Perform a thorough review of systems to identify any new or ongoing issues.
Ob-Gyn Hx (if applicable):

Obtain relevant obstetric and gynecologic history for female patients.
Additional Notes:

Use this space to document any additional information or questions to address during the patient interview.
Evidence-Based Medicine Considerations (For Reference):

Adherence: Prioritize adherence assessment and support.
Smoking Cessation: Encourage and support smoking cessation.
Alcohol and Drug Use: Screen for harmful use and provide appropriate interventions.
PrEP/PEP: Offer PrEP or PEP when indicated.
Cardiovascular Risk: Assess and manage cardiovascular risk factors.
Opportunistic Infections: Follow guidelines for prophylaxis.
Instructions for Use:

Before the Visit: Complete the patient information and reason for visit sections.
During the Visit: Utilize the pre-charting template as a guide during the patient interview, filling in the relevant sections as you gather information.
Post-Visit: Review and complete any remaining sections, ensuring a comprehensive and accurate medical record.
This pre-charting template serves as a structured tool to streamline the patient interview process, facilitate evidence-based decision-making, and ensure comprehensive data collection for optimal HIV care.

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.33, 23 form elements, 186 boilerplate words, 7 text boxes, 1 text areas, 2 dates, 1 radio buttons, 1 drop downs, 11 comments, 12 total clicks
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