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Medical Equipment
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MEDICAL EQUIPMENT IN THE HOME
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Standard H&P
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Hospice
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Alzheimers Disease
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GENERAL:
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Negatives
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General
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General Comments
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SKIN:
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Skin Comments
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negatives
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Skin
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HEENT:
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HEENT Comments
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negatives
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HEENT
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CARDIOVASCULAR:
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CV Comments
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negatives
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Cardiovascular
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RESPIRATORY:
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Resp Comments
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negatives
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Respiratory
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GI:
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GI Comments
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negatives
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GI
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URINARY:
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Urinary Comments
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negatives
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Urinary
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MUSCULOSKELETAL:
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MSK Comments
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negatives
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MSK
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PSYCHIATRIC:
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Psychiatric Comments
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negatives
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Psychiatric
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Falls since last visit
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GENERAL (no weakness beyond baseline, no fatigue beyond baseline, no fever, no significant weight change)
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Negatives
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General
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General Comments
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SKIN (no rash, no lumps, no sores, no ulcers, no itching, no dryness, no color change, no changes in hair or nails)
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negatives
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Skin
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Skin Comments
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HEENT (no headache, no head injury, no dizziness, no vision changes, no hearing problems beyond baseline, no tinnitus, no verti)
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negatives
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HEENT
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HEENT Comments
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NECK (no lumps, no lymphadenopathy, no goiter, no pain, no stiffness)
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negatives
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Neck
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Neck Comments
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BREASTS (no lumps, no pain or discomfort, no nipple discharge)
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negatives
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Breasts
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Breasts Comments
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CARDIOVASCULAR (no chest pain or discomfort, no palpitations, no orthopnea, no paroxysmal nocturnal dyspnea)
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negatives
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Cardiovascular
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CV Comments
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RESPIRATORY ( no sputum, no hemoptysis, no dyspnea, no wheezing, no cough beyond baseline)
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negatives
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Respiratory
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Resp Comments
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GI (no trouble swallowing, no nausea, no vomiting, no diarrhea, no rectal bleeding or tarry stools, no abdominal pain)
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negatives
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GI
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GI Comments
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URINARY (no polyuria, no burning or pain on urination, no hematuria, no apparent urinary infections, no kidney stones, baseline)
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negatives
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Urinary
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Urinary Comments
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GENITAL (MALE) (no hernias, no discharge, no sores, no testicular pain or masses, no lesions)
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negatives
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Genital (Male)
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Genital (Male) Comments
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GENITAL (female) (no vaginal discharge, no itching, no dyspareunia)
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negatives
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Genital (Female)
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Genital (Female) Comments
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PERIPHERAL/VASCULAR (no intermittent claudication, no leg cramps, no varicose veins)
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negative
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Periph. Vasc.
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Periph. Vasc. Comments
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MSK (no gout, no swelling, no redness, no tenderness)
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negatives
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MSK
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MSK Comments
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NEUROLOGICAL (no fainting, no blackouts, no seizures, no weakness, no paralysis, no numbness or loss of sensation, no tingling)
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negatives
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Neurological
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Neuro Comments
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ENDOCRINE (no heat or cold intolerance, no excessive sweating, no excessive thirst or hunger, no polyuria)
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negatives
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Endocrine
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Endo Comments
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PSYCHIATRIC (no nervousness, no depression, no memory change)
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negatives
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Psychiatric
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Psychiatric Comments
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Parkinson's
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GENERAL:
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General Comments
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Negatives
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General
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SKIN (no rash, no lumps, no sores, no ulcers, no itching, no dryness, no color change, no changes in hair or nails)
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Skin Comments
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negatives
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Skin
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HEENT (no indications or complaints of headache, no head injury, no indications or complaints of vision changes, no hearing pro)
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HEENT Comments
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negatives
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HEENT
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CARDIOVASCULAR (no indications of chest pain or discomfort, no palpitations)
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CV Comments
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negatives
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Cardiovascular
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RESPIRATORY (no hemoptysis, no dyspnea, no wheezing; chronic cough, SOB w/ exertion)
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Resp Comments
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negatives
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Respiratory
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GI (no nausea, no vomiting, no diarrhea, no rectal bleeding or tarry stools, no abdominal pain; chronic constipation, bowel)
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GI Comments
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negatives
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GI
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URINARY: (no foul smelling urine noted by caregivers, no burning or pain w/ urination, no hematuria, incontinent of bladder)
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Urinary Comments
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negatives
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Urinary
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MUSCULOSKELETAL (no complaints of backache, no redness; worsening stiffness & muscle weakness, unable to ambulate safely, falls)
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MSK Comments
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negatives
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MSK
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PSYCHIATRIC (no anxiety, no behavioral problems, baseline parkinsonian dementia)
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Psychiatric Comments
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negatives
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Psychiatric
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Falls over the last benefit period
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COPD
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General [-]
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General Comments
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Negatives
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General
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Skin [-]
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Skin Comments
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negatives
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Skin
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HEENT [-]
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HEENT Comments
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negatives
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HEENT
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Cardiovascular [-]
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CV Comments
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negatives
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Cardiovascular
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Respiratory [-]
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Resp Comments
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negatives
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Respiratory
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GI [-]
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GI Comments
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negatives
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GI
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Urinary [-]
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Urinary Comments
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negatives
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Urinary
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MSK [-]
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MSK Comments
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negatives
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MSK
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Psychiatric [-]
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Psychiatric Comments
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negatives
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Psychiatric
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Falls over the last benefit period
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Cardiac
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General [-]
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General Comments
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Negatives
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General
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Skin [-]
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Skin Comments
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negatives
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Skin
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HEENT [-]
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HEENT Comments
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negatives
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HEENT
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Cardiovascular [-]
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CV Comments
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negatives
• • •
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Cardiovascular
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Respiratory [-]
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Resp Comments
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negatives
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Respiratory
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GI [-]
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GI Comments
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negatives
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GI
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Urinary [-]
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Urinary Comments
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negatives
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Urinary
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MSK [-]
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MSK Comments
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negatives
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MSK
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Psychiatric [-]
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Psychiatric Comments
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negatives
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Psychiatric
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Falls over the last benefit period
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Vascular Dementia
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GENERAL:
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General Comments
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Negatives
• • •
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General
• • •
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SKIN (no rash, no lumps, no sores, no ulcers, no itching, no dryness, no color change, no changes in hair or nails)
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Skin Comments
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negatives
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Skin
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HEENT (no indications or complaints of headache, no head injury, no indications or complaints of vision changes, no hearing pro)
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HEENT Comments
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negatives
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HEENT
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CARDIOVASCULAR (no indications of chest pain or discomfort, no palpitations)
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CV Comments
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negatives
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Cardiovascular
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RESPIRATORY (no hemoptysis, no dyspnea, no wheezing; chronic cough, SOB w/ exertion)
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Resp Comments
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negatives
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Respiratory
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GI (no nausea, no vomiting, no diarrhea, no rectal bleeding or tarry stools, no abdominal pain; chronic constipation, bowel)
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GI Comments
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negatives
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GI
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URINARY: (no foul smelling urine noted by caregivers, no burning or pain w/ urination, no hematuria, incontinent of bladder)
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Urinary Comments
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negatives
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Urinary
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MUSCULOSKELETAL (no complaints of backache, no redness; worsening stiffness & muscle weakness, unable to ambulate safely, falls)
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MSK Comments
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negatives
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MSK
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PSYCHIATRIC (no anxiety, no behavioral problems, baseline parkinsonian dementia)
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Psychiatric Comments
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negatives
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Psychiatric
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Falls over the last benefit period
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Generic
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GENERAL (progressively worsening muscle weakness, worsening fatigue, worsening sleepiness during the day (daytime somnolence))
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General Comments
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Negatives
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General
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SKIN (no rash, no lumps, no sores, no ulcers, no itching, no dryness, no color change, no changes in hair or nails)
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Skin Comments
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negatives
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Skin
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HEENT (no indications or complaints of headache, no head injury, no indications or complaints of vision changes, no hearing pro)
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HEENT Comments
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negatives
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HEENT
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CARDIOVASCULAR (lightheadedness, intermittent chest pains reduced with relaxation, SOB w /minimal exertion)
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CV Comments
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negatives
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Cardiovascular
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RESPIRATORY (no wheezing, sputum production, coughing up blood; <b>chronic cough, shortness of breath with exertion)
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Resp Comments
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negatives
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Respiratory
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GI (no nausea, no vomiting, no diarrhea, no rectal bleeding or tarry stools, no abdominal pain; chronic constipation)
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GI Comments
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negatives
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GI
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URINARY ( bladder incontinence, no foul smelling urine, no urgency, no frequency)
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Urinary Comments
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negatives
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Urinary
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MUSCULOSKELETAL (worsening muscle weakness, high fall risk)
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MSK Comments
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negatives
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MSK
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PSYCHIATRIC (no depression, no anxiety, no behavior issues)
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Psychiatric Comments
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negatives
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Psychiatric
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Falls over the last benefit period
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COPD
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General [-]
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Negatives
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General Comments
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Skin [-]
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Skin Comments
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negatives
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Skin
• • •
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HEENT [-]
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HEENT Comments
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negatives
• • •
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HEENT
• • •
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Cardiovascular [-]
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CV Comments
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Cardiovascular
• • •
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Respiratory [-]
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Resp Comments
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negatives
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Respiratory
• • •
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GI [-]
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GI Comments
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negatives
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GI
• • •
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Urinary [-]
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Urinary Comments
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negatives
• • •
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Urinary
• • •
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MSK [-]
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MSK Comments
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negatives
• • •
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MSK
• • •
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Psychiatric [-]
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Psychiatric Comments
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negatives
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Psychiatric
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Falls over the last benefit period
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