DOD ASSESSMENT/PLAN

ASSESSMENT:
[text name="variable_1"] presenting with [text name="variable_3"] for [text name="variable_4"]. [textarea name="variable_5" default=""] Patient is well-appearing and nontoxic overall. Differential diagnosis includes but is not limited to the following:

[textarea name="variable_7"]

PLAN OF TESTING AND TREATMENT: 
[text name="variable_8" default=""]
[text name="variable_9" default=""]
[text name="variable_10" default=""]
[text name="variable_11" default=""]

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 [checkbox name="variable_12" value="within 24-48 hours|within 48-72 hours|within 1 week|as needed"] for reevaluation. The patient understands to report immediately to the nearest Emergency Department or Urgent Care Center for any concerning/worsening signs or symptoms.