CLINICAL PROGRESS NOTE: FOLLOW-UP VISIT
CLINICAL PROGRESS NOTE: FOLLOW-UP VISIT Date of Service: [date name="variable_1" default="07/25/2021"] Patient`s Name:________________________ DOB:____________ [checkbox name="variable_1" value="ALF|SNF|LTF|HOSPICE|REHAB"] [checkbox name="variable_6" value="Patient was seen and examined in person"] [checkbox name="variable_7" value="Chart Reviewed"] [checkbox name="variable_8" value="Lab Reviewed"] [checkbox name="variable_9" value="CBC|CMP|BMP|UA|TSH|HBA1c|DILANTIN|DIGOXIN|PTINR|LIPID PANEL|RENAL PANEL"] [comment memo="DIAGNOSTIC STUDIES:"] CHIEF COMPLAINT: [textarea name="variable_1" default=""] HPI: [textarea name="variable_2" default=""] CHRONIC MEDICAL CONDITIONS REVIEWED: [checkbox name="10" value="HTN|EDEMA|FALLS|HLD|ANEMIA|ANXIETY|DEMENTIA|COPD|BPH|TYPE 2 DIABETES|HYPOTHYROID|CANCER|CKD|GERD|DEPRESSION|CHF|CVA|CAD|OA|AFIB|PAIN"] PAST SURGICAL HISTORY: [textarea name="variable_3" default=""] EXAMINATION: [comment memo="Vital Signs"] TEMP:[text name="variable_4" default=""] HR: [text name="variable_5" default=""] RESP:[text name="variable_6" default=""] BP: [text name="variable_7" default=""] APPEARANCE: [text name="variable_8" default=""] GAIT: [text name="variable_9" default=""] Level of Consciousness: [text name="variable_10" default=""] [checkbox name="variable_10" value="Alert|Drowsy|Lethargic|Non-Arousable"] FAMILY/SOCIAL HISTORY: [checkbox name="variable_11" value="Unchanged from history documented in initial psychiatric evaluation and subsequent notes."] [checkbox name="variable_12" value="New information:"] [textarea name="variable_4" default=""] ROS: Explain Positives(Check Items)Below. Constitutional-[checkbox name="Constitutional" value="Positive|Negative"] Eyes-[checkbox name="Eyes" value="Positive|Negative"] Ears/Nose/Mouth/Throat-[checkbox name="ENT" value="Positive|Negative"] CV-[checkbox name="CV" value="Positive|Negative"] Respiratory-[checkbox name="Respiratory" value="Positive|Negative"] GI-[checkbox name="GI" value="Positive|Negative"] GU-[checkbox name="GU" value="Positive|Negative"] Musculoskeletal-[checkbox name="Musculoskeletal" value="Positive|Negative"] Skin/Breast-[checkbox name="skin" value="Positive|Negative"] Neurological-[checkbox name="Neurological" value="Positive|Negative"] Endocrine-[checkbox name="Endocrine" value="Positive|Negative"] Heme/Lymph-[checkbox name="Heme" value="Positive|Negative"] Allergic Immunologic-[checkbox name="AllergicImmunologic" value="Positive|Negative"] Additional ROS Comments: [textarea name="ROS_Comments" default=""] ASSESSMENT AND PLAN: [textarea name="ASSESSMENT_PLAN" default=""] PATIENT RESPONSE TO TREATMENT: [textarea name="PATIENT_RESPONSE" default=""] Risks, benefits, Side Effects, Drug-to-Drug Interactions and Alternatives to treatment were discussed in my usual manner:[checkbox name="GP" value="YES|NO"] TOPIC DISCUSSED: [checkbox name="TOPICDISCUSSED" value="CARE/ADVANCED CARE PLANNING|FULL CODE|DNR|DNI|DNH"] [checklist name="Checklist" value="Nature of Diagnosis and/or Prognosis|Medical Record Reviewed|Aspect of aging process and relationship to the current problem|Nature of possible Treatment|Risk of non-treatment|communication with family/caregiver|Forms/Reports Filled out|Family and/or Situational stressors|Other"] TREATMENT RECOMMENDATIONS/FOLLOW UPS: [textarea name="Follow_UPS" default=""] Physician/Nurse Practitioner Name: [text name="NPNAME" default=""] Signature: [text name="SIGN" default=""] DATE: [date name="Date" default="07/25/2021"]
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Sandbox Metrics: Structured Data Index 0.61, 46 form elements, 98 boilerplate words, 9 text boxes, 8 text areas, 2 dates, 24 checkboxes, 1 check lists, 2 comments, 107 total clicks
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