Evaluation

This patient consented to evaluation and treatment by a resident physician under the supervision of an attending. Patient, resident, and attending discussed diagnoses, medications, and treatment recommendations and provided the opportunity to address any questions or concerns. Participation in the management of the patient is indicated by edits of the note and electronic signature affixed to this encounter.

[checkbox name="Doxy" value="Patient agreed to be seen virtually, using DOXY, a HIPAA-compliant medium."]

Time Spent Reviewing Chart: [text name="Number"] minutes
Time of Appointment: [text name="Times"]

Name: [text name="Name"]
Age: [text name="Age"]
Gender: [select name="Gender" value="Cis-male|Cis-female|Trans-male|Trans-female|Non-binary"]

Chief Complaint: [text name="CC"]

HPI:
[textarea name="HPI"]

Current Medications: [text name="Medications"]

ROS:
[textarea name="ROS"]

Psychiatric History:
History:
[textarea name="History"]
Past medications: [text name="Pastmeds"]
Outpatient History: [text name="OPHx"]
Inpatient History: [text name="IPHx"]
SA/NSSI: [text name="SA"]

Substance Use:
[textarea name="substance"]

Trauma/Abuse/Neglect:
[textarea name="TAN"]

Psychosocial:
Living: [text name="living"]
Education: [text name="education"]
Finance: [text name="finance"]
Supports: [text name="supports"]
Social: [text name="social"]
Military: [text name="military"]
Legal: [text name="legal"]

Developmental:
[textarea name="developmental"]

Medical History:
Medical: [text name="medical"]
Surgical: [text name="surgical"]
Allergies: [text name="allergies"]