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HPI
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Generic FU
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Problem #1
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what is the Problem?
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Problem #2
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Interval Changes
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Problem #3
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Course
• • •
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Problem # 4
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Modifiers and treatment
• • •
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Chronic pain complicated
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Hypertension(HTN) uncontrolled
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Interval changes
• • •
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Interval changes
• • •
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QUALITY/SEVERITY
• • •
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Course
• • •
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INTENSITY/SEVERITY
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Intensity
• • •
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MODIFIERS/TREATMENT
• • •
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Related symptoms
• • •
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FUNCTION LEVEL
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ROS positive
• • •
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ROS
• • •
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ROS negative
• • •
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Pain contract (Plan)
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DM uncontrolled
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Hyperlipidemia
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Average fasting BS
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Current medications
• • •
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Interval changes
• • •
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Course
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HgA1C
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LDL/ALT
/
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Course
• • •
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Compliance
• • •
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Compliance and Screening
• • •
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Related symptoms
• • •
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Renal insufficiency
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Hypothyroidism
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Cr/GFR
/
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Current dose
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Course
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Last TSH
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Stage
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Course
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Modifier/Treatment
• • •
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Related symptoms
• • •
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ROS
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General [-]
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General [+]
• • •
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General Comments
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Skin [-]
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Skin [+]
• • •
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Skin Comments
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HEENT [-]
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HEENT [+]
• • •
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HEENT Comments
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Neck [-]
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Neck [+]
• • •
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Neck Comments
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Breasts [-]
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Breasts [+]
• • •
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Breasts Comments
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Cardiovascular [-]
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Cardiovascular [+]
• • •
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CV Comments
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Respiratory [-]
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Respiratory [+]
• • •
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Resp Comments
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GI [-]
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GI [+]
• • •
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GI Comments
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Urinary [-]
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Urinary [+]
• • •
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Urinary Comments
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Genital (Male) [-]
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Genital (Male) [+]
• • •
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Genital (Male) Comments
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Genital (Female) [-]
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Genital (Female) [+]
• • •
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Genital (Female) Comments
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Periph. Vasc. [-]
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Periph. Vasc. [+]
• • •
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Periph. Vasc. Comments
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MSK [-]
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MSK [+]
• • •
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MSK Comments
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Neurologic [-]
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Neurologic [+]
• • •
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Neuro Comments
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Endocrine [-]
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Endocrine [+]
• • •
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Endo Comments
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Psychiatric [-]
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Psychiatric [+]
• • •
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Psychiatric Comments
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