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HPI
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The patient reports
• • •
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Negative for
• • •
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The patient denies
• • •
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PHYSICAL EXAM
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General WNL
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General Abnormal
• • •
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General Comments
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HEENT WNL
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HEENT Abnormal
• • •
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HEENT Comments
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Skin WNL
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Skin Lesion
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Skin Comments
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Cardiovascular WNL
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Cardiovascular Abnormal
• • •
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Cardiovascular Comments
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Lungs WNL
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Lungs Abnormal
• • •
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Lungs Comments
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Abdomen WNL
|
Abdomen normal
• • •
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Abdomen Abnormal
• • •
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Abdomen Comments
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Extremities WNL
|
Extrem Abnormal
• • •
|
|
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Extrem Comments
|
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ASSESSMENT
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|
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Assessment
• • •
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Assessment
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PLAN
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|
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Rx
• • •
|
Plan
• • •
|
|
New Short Text Field
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|
|
FOLLOW UP
• • •
|
Follow up free text
|
