Exercise Therapy Progress Note

Name[text name="variable_1" default="sample text"]DOB[text name="variable_1" default="sample text"][date name="variable_1" default="01/20/2020"]
HT[text name="variable_1" default="sample text"]WT[text name="variable_1" default="sample text"]BMI[text name="variable_1" default="sample text"]
BP[text name="variable_1" default="sample text"]Pulse[text name="variable_1" default="sample text"]
Patient Goals
[textarea name="variable_1" default="sample text"]
Subjective
[textarea name="variable_1" default="sample text"]
Objective
[textarea name="variable_1" default="sample text"]
Assessment
[textarea name="variable_1" default="sample text"]
Plan
Extensive counseling regarding diet, exercise, behavioral modifications and lifestyle changes.
Food / exercise journal
Supplements:  MVI / B12 / CA / Iron / Vit D
Nutritional Evaluation
Fitness Evaluation	
Exercise Therapy				
Other:[text name="variable_1" default="sample text"]

Potential for achieving goals:
[select name="variable_1" value="Excellent|Good|Fair"]