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Patient Consultation Progress Note
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Patient ID#:
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Chief Complaint:
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Consult Requested by
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Allergies to Meds:
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Medications
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History of Present Illness
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Location
• • •
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Location Comments
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Onset / Timing
• • •
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Onset Comments
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Quality
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Quality Comments
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Context
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Severity
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Severity Comments
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Duration
• • •
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Duration Comments
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Associated Signs and Symptoms
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HPI
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PMHX
• • •
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History of Sunburns:
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Sun Protection
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Sunscreen
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SPF:
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FHX of skin cancer:
• • •
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Who?
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Social HX
• • •
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Other:
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Surgical HX
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ROS
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Constitutional
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Musculoskeletal
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HEENT
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Neurologic
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Cardiovascular
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Skin
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Respiratory
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Psych
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G/I
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Endocrine
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G/U
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Hematology/Lymphatic
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Immunologic
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Physical Exam
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General: Patient appears:
• • •
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Other:
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HEENT
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Cardiovascular: Edema
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If yes: Level:
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Where:
• • •
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Varicosities
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Lymphadenopathy
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If yes, where?
• • •
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Extremities (selected items indicate site was examined - refer to map for details) - Skin :
• • •
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Hyperhydrosis
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Neuro/Psych: A&O
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Medical Decision Making:
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Pathology reviewed with patient
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Surgical risks discussed with patient
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Signature: Lydia Anders, PA-C
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Signature - Mark S. Potenza, MD
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Chart was reviewed by Mark S Potenza, MD
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