PCM Write Up

Identifying Data
Date:
[date name="variable_1" default="09/08/2020"]
Source:
[text name="variable_2" default="sample text"], [select name="variable_3" value="reliable|unreliable"],[text name="variable_4" default="location"]
Language:
[text name="variable_5" default="sample text"] used
Chief Compaint:
"[textarea name="variable_6" default="Sample text"]" x[text name="variable_7" default="#"] [select name="variable_8" value="hours|days|weeks|months"] 

History of Present Illness:
[textarea name="variable_18" default="Character,Location,Onset,Duration,Intensity,Exacerbation,Remission,Radiation,Setting,Social/Psych,Associated Symptoms,Explanation,Treatments,Healers"]


Past Medical History:
Hospitalizations/Surgery:
[text name="variable_19" default="date"]-[textarea name="variable_20" default="reason/procedure"],[select name="variable_21" value="non-complicated|complicated"]
Injuries/Accidents:
[text name="variable_22" default="date"]-[textarea name="variable_23" default="sample text"]
Major Illnesses:
Childhood Diseases: +
[checklist name="variable_24" value="Measles,|Mumps,|Rubella,|Chicken Pox,|Rheumatic Fever"].Denies [checklist name="variable_25" value="Measles,|Mumps,|Rubella,|Chicken Pox,|Rheumatic Fever"]
Adult Disease: +[checklist name="variable_26" value="Hypertension,|Coronary Artery Disease,|COPD,|Asthma,|DM,|Hyperlipidemia"]. Denies [checklist name="variable_27" value="Hypertension,|Coronary Artery Disease,|COPD,|Asthma,|DM,|Hyperlipidemia"].

OB/GYN:
Menstrual:[text name="variable_9" default="menarche"]x[text name="variable_10" default="frequency"]x[text name="variable_11" default="length of flow"],[select name="variable_12" value="light flow|moderate flow|heavy flow"]. LMP, [date name="variable_28" default="09/08/2020"].

Obstetric: G[text name="variable_13" default="#"]P[text name="variable_14" default="#"]F[text name="variable_15" default="#"]A[text name="variable_16" default="#"]L[text name="variable_17" default="#"]
Menopause: [select name="variable_29" value="N/A|Peri-menopausal|Post-menopausal"]
[conditional field="variable_30" condition="select name="variable_29" value="Peri-menopausal|Post-menopausal"] display if condition is true [text name="variable_31" default="#"-years-old]


Psychiatric:
Transfusions:
Current Medications:
Allergies:
Family History
Current Health/Risk Factors
Nutrition:
Smoking:
Alcohol: CAGE
Other Drugs:
Sleep:
Health Exams:
Immunizations:
Injury Prevention:
Chemoprophylaxis:
Social History
Personal Status: 
Culture/Religion:
Support System:
Socioeconomic Data:
Domestic Violence: HITS
Occupation:
Sexual Behavior:
Military Record:
Travel:
Review of Systems
General:
Skin:
HEENT:
Neck:
Breast:
Respiratory:
Cardiac:
GU:
GI:
Musculoskeletal:
Neurologic:
Hematologic:
Endocrine:
Psychiatric:
Physical Exam
Vitals: T: P: BP: H: W: BMI:
General:
Musculoskeletal:
Cardiovascular:
Respiratory:
Abdominal:
Problems List
Summary
Differential Diagnosis