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"]