Telemedicine Rod

This visit was performed via telemedicine.
The patient confirmed knowledge of the limitations of the use of telemedicine were verbally confirmed by the provider.
Verification of patient identity was established with the patient. Patient consents to telemedicine.

Verbal consent was obtained for medical treatment in lieu of coronavirus related emergency

The patient is being interviewed via phone for [text] 
Patient had the symptmos x  [select name="variable_1" value="1|2|3|4|5|6|7"][select name="variable_3" value="days|weeks|months"].

Associated symptoms[textarea name="variable_1" default=""]

Other symptoms: [checklist name="variable_1" value=" Fever|sore throat|nasal congestion|earache|PND|heartburn|headache|myalgias"]

Over the counter medications/remedies that have been tried are [text].

Patient has [select value="no known|known"] sick contacts
Patient has no recent travel


History of pulmonary problems:  [checkbox name="pulmhx" value="no respiratory problems|frequent pneumonia|frequent bronchitis|asthma|other"][conditional field="pulmhx" condition="(pulmhx).is('other')"][text size=72 memo="<--describe other"][/conditional].
Tobacco: [checkbox name="tobacco" value="Patient is not a smoker|Patient is a current or former smoker|Patient is exposed to second hand smoke"][conditional field="tobacco" condition="(tobacco).is('Patient is a current or former smoker')"] [text size=72 memo="<--smoking details (optional)"][/conditional].

PE/DVT risk factors/ other risk factors

[checklist name="variable_4" value="chest pain|dyspnea|lower ext edema|hemoptasis | recent travel"]


Diagnostic rationale, follow up instructions, and strict precautions/indications for emergent direct evaluation were discussed with the patient. The patient agrees with the plan, and understands to follow up with their primary care physician or other healthcare provider within 48-72 hours for reevaluation for persistent or worsening symptoms.