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History & Physical
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Progress note
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Annual Wellness Visit
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Transitional Care Visit
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Seen by request of
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Seen by request of patient/caregiver for
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Place of exam
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Medical Necessity
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HPI
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Code Status
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Information from
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Past Medical History
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Past Medical History Comments
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Past Surgical History
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Past Surgical History Comments
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Past Social History
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Past Social History Comments
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Father PMH
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Father PMH Comments
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Mother PMH
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Mother PMH Comments
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Relative PMH
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Relative PMH Comments
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Immunizations
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Immunizations Comments
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Screenings
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Screening Comments
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Fall Risk
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Safety
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Diet
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Other Providers
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Recent lab
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Recent Lab Comments
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PHQ2
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Little interest or pleasure in doing things
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Feeling down, depressed or hopeless
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PHQ2 Score
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ROS
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General
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General Comments
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HEENT
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HEENT Comments
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Respiratory
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Respiratory Comments
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CV
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CV Comments
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GI
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GI Comments
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GU
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GU Comments
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Integumentary
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Integumentary Comments
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MSK
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MSK Comments
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Neuro
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Neuro Comments
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Endocrine
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Endocrine Comments
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Psychological
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Psychological Comments
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Functional Status
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Functional Status Comments
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Chart review/medication reconcilliation
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Objective
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General
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General Comments
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HEENT
• • •
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HEENT Comments
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Respiratory
• • •
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Respiratory Comments
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CV
• • •
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CV Comments
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GI
• • •
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GI Comments
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GU
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GU Comments
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MSK
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MSK Comments
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Integumentary
• • •
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Integumentary Comments
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Neuro
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Neuro Comments
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Psych
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Psych Comments
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Functional Status
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Functional Status Comments
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Assessment
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Assessment #1
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Assessment #1 Comments
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Assessment #2
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Assessment #2 Comments
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Assessment #3
• • •
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Assessment #3 Comments
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Assessment #4
• • •
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Assessment #4 Comments
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Assessment #5
• • •
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Assessment #5 Comments
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Assessment #6
• • •
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Assessment #6 Comments
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Assessment #7
• • •
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Assessment #7 Comments
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Assessment #8
• • •
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Assessment #8 Comments
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Assessment #9
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Assessment #9 Comments
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Assessment #10
• • •
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Assessment #10 Comments
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Plan
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Lab
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Lab Comments
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Imaging/Special Tests
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Imaging/Special Tests Comments
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General Instructions
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General Instructions Comments
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Home Health
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Home Health Comments
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Hospice
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Hospice Comments
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Referrals
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Referrals Comments
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Prolonged Visit
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Prolonged visit time
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Prolonged Visit Comments
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Follow Up
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Follow Up Comments
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