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CC:
HPI (fillable with macro buttons or free-text)
Meaningful Use:
1) Depression Screening
N/A
In the last two weeks, have you been bothered by Little interest or pleasure in doing things?
In the last two weeks, have you been bothered by Feeling down, depressed or hopeless?
If "YES" to either of the above questions, click here.
Over the past two weeks, how often have you been bothered by little interest of pleasure in doing things?
Over the past two weeks, how often have you been bothered by feeling down, depression or hopeless?
Over the past two weeks, how often have you been bothered by trouble falling or staying asleep or sleeping too much?
Over the past two weeks, how often have you been bothered by feeling tired or having little energy?
Over the past two weeks, how often have you been bothered by poor appetite or overeating?
Over the past two weeks, how often have you been bothered by feeling bad about yourself or that you are a failure or let down?
... trouble concentrating on things such as reading the newspaper or watching television?
... Moving or speaking so slowly that others have noticed? Or being fidgety and restless?
...Thoughts that you were better off dead or of hurting yourself in some way?
Total is out of 27 points. [Depression Severity: 0-4 = none, 5-9 = mild, 10-14 = moderate, 15-19 = mod. severe, 20-27 = severe]
Interpretation
Depression Screening Selection
Negative screen for clinical depression, f/u not required. (G8510)
Positive screen for clinical depression with a documented follow-up plan (G8431)
Screening for clinical depression not documented, pt not eligible/appropriate (G8433)
Screening for clinical depression documented, f/u plan not documented, pt not elig/appropriate (G8940)
2) Med list documented, reviewed
N/A
a. Yes
b. No
3) Allergies and current problems list
N/A
Reviewed and reconciled: Yes
4) BMI:
N/A
a. In normal range, 18.5 - 25
b. BMI > 25, follow-up plan documented
c. BMI < 18.5, follow up plan documented
d. BMI not documented, pt not eligible
5) Tobacco Screening:
N/A
a. Tobacco non user
b. Tobacco user
i. Tobacco user, received brief counselling and/or pharmacotherapy
ii. Tobacco user, did not receive smoking cessation intervention
c. Tobacco screening not performed for medical reasons
6) HTN screening
N/A
a. Normal BP, follow up not required
b. Prehypertensive or hypertensive, follow up plan documented
c. BP not screened, pt refused or emergenty ill
d. Not eligible for screening as patient has active diagnosis of HTN
i. SBP < 140 mmHg
ii. SBP > 140 mmHg
iii. DBP < 90 mmHg
iv. DBP > 90 mmHg
7) Diabetes Control checked in the past 12 months
N/A
a. A1C >9%
b. A1C 7-9%
c. A1C < 7%
A1C not performed in the last 12 months
8) Diabetes with eye exam in the last 12 months
N/A
a. Dilated retinal exam documented and reviewed
b. Low risk for retinopathy from prior year
9) Diabetes with foot exam in the past 12 months
N/A
a. Foot Exam Performed
b. Date of exam
c. Comments

H&P CC / History of Present Illness Medical Form

Endocrinology

There are 1 copies in use.
Published: April 6, 2018, 1:45 p.m.
Doctor: Dr. History Physical
Rating: 0   /

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