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Initial Assessment (MD/DO)
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U/C Physician Name
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Notes from Initial Consultation by Physician:
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HPI
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Additional Past Medical HX
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PMH Dropdown
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Social HX
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Family HX
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LMP (For UTI, Etc)
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General ROS
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General Comments
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Oral meds ordered:
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Injectable meds ordered:
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Labs Ordered:
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Additional communication to nurse
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Nurse Evaluation:
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Name of Nurse examiner:
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Reminder: complete MEDS & Allergies of SOAP
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"Vitals" tab completed
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General findings
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General Comments
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HEENT Findings
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HEENT Comments
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Skin Findings
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Skin Comments
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Neck Findings
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Neck Comments
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Cardiovascular Findings
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Cardiovascular Comments
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Lung Findings
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Lungs Comments
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Abdomen Findings
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Abdomen Comments
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MSK Findings
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MSK Comments
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Breasts Findings
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Breasts Comments
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Neuro Findings
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Neuro Comments
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Extrem Findings
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Extrem Comments
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Body Diagram
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Face diagram
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Point of Care Testing
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Point of Care Testing Comments
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Oral meds given during visit:
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Other oral meds given
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Injectable meds given during visit:
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Dose of injectables/liquids
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Topicals/Drops/Pumps given during visit:
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Additional Nurse Notes:
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Post-visit Doctor Notes:
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(MD/DO) Plan:
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Referred to ER STAT
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Patient strongly preferred antibiotic treatment
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General Instructions
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General Instruction Comments
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Wound Care
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Wound Care Comments
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Notes to follow up nurse:
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Additional notes for follow up:
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Patient was signed over to another clinician
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Person to whom patient was endorsed:
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Working diagnosis or R/O
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Type of visit expected of receiving clinician:
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Time of expected visit
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Stat Imaging Pending:
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Stat labs pending:
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Other expected service pending:
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Labs for nurse collection:
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Actions required: If study is positive
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Actions required: If study is negative
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Method of Sign Out
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Time of Sign Out:
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Changes to service location or contact info
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Additional transfer of care notes:
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