Assessment & Plan Elements
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Date of Visit
[date name="variable_1" default="00/00/20--"]

Identifying Data
Age:[text name="Value_Generic" size="5"]
Gender:[text name="Value_Generic1" size="5"]
Occupation:[text name="Value_Generic2" size="60"]
Marital Status:[text name="Value_Generic3" size="30"]
Living/Housing Situation:[text name="Value_Generic4" size="60"]

Subjective
Chief Complaint or Appropriate Health Screening Visit: [text name="Value_Generic11" size="100"]
History of Present Illness: [text name="Value_Generic12" size="100"]
Past Medical History: [text name="Value_Generic13" size="100"]
Family History: [text name="Value_Generic14" size="100"]
Personal and Social History: [text name="Value_Generic" size="100"]

Review of Systems
Constitutional: [text name="Value_Generic_const" size="100"]
Eyes: [text name="Value_Generic_eyes" size="100"]
EENT: [text name="Value_Generic_EENT" size="100"]
Cardiovascular: [text name="Value_Generic_cardio" size="100"]
Respiratory: [text name="Value_Generic_resp" size="100"]
Gastrointestinal: [text name="Value_Generic_gastro" size="100"]
Genitourinary:[text name="Value_Generic_genito" size="100"]
Musculoskeletal: [text name="Value_Generic_musculo" size="100"]
Integumentary: [text name="Value_Generic_integ" size="100"]
Neurological: [text name="Value_Generic_neuro" size="100"]
Psychological: [text name="Value_Generic_psych" size="100"]
Endocrine: [text name="Value_Generic_endo" size="100"]
Allergic/Immunologic: [text name="Value_Generic_immuno" size="100"]

Objective
Vital Signs
Blood Pressure:[text name="Value_Generic21" size="5"]
Temperature:[text name="Value_Generic22" size="5"]
Pulse:[text name="Value_Generic23" size="5"]
Respirations:[text name="Value_Generic24" size="5"]
Height:[text name="Value_Generic25" size="5"]
Weight:[text name="Value_Generic26" size="5"]
BMI:[text name="Value_Generic27" size="5"]

Physical Exam
General: [text name="Value_Generic_gen1" size="100"]
Skin:[text name="Value_Generic_skin1" size="100"]
Head: [text name="Value_Generic_head1" size="100"]
Eye(s): [text name="Value_Generic_eyes1" size="100"]
ENMT: [text name="Value_Generic_ENMT1" size="100"]
Neck: [text name="Value_Generic_neck1" size="100"]
Cardiovascular: [text name="Value_Generic_cardio1" size="100"]
Respiratory: [text name="Value_Generic_resp1" size="100"]
Chest Wall: [text name="Value_Generic_chestwall1" size="100"]
Gastrointestinal: [text name="Value_Generic_GI1" size="100"]
Genitourinary:[text name="Value_Generic_GU1" size="100"]
Musculoskeletal: [text name="Value_Generic_musculo1" size="100"]
Neurological: [text name="Value_Generic_neuro1" size="100"]
Lymphatics: [text name="Value_Generic_lymph1" size="100"]
Psychological: [text name="Value_Generic_psych1" size="100"]

Assessment and Plan
Differential Diagnosis: [text name="Value_Genericx" size="100"]
Rationale: [text name="Value_Genericc" size="100"]
Diagnosis: [text name="Value_Genericv" size="100"]
Plan:[text name="Value_Generi_plan" size="100"]
Date of Visit


Identifying Data
Age:
Gender:
Occupation:
Marital Status:
Living/Housing Situation:

Subjective
Chief Complaint or Appropriate Health Screening Visit:
History of Present Illness:
Past Medical History:
Family History:
Personal and Social History:

Review of Systems
Constitutional:
Eyes:
EENT:
Cardiovascular:
Respiratory:
Gastrointestinal:
Genitourinary:
Musculoskeletal:
Integumentary:
Neurological:
Psychological:
Endocrine:
Allergic/Immunologic:

Objective
Vital Signs
Blood Pressure:
Temperature:
Pulse:
Respirations:
Height:
Weight:
BMI:

Physical Exam
General:
Skin:
Head:
Eye(s):
ENMT:
Neck:
Cardiovascular:
Respiratory:
Chest Wall:
Gastrointestinal:
Genitourinary:
Musculoskeletal:
Neurological:
Lymphatics:
Psychological:

Assessment and Plan
Differential Diagnosis:
Rationale:
Diagnosis:
Plan:

Result - Copy and paste this output: