|
Medical/Surgical History
|
|
|
Medical History
• • •
|
PMH (free text)
|
|
Surgical History
• • •
|
Surgical hx (free text)
|
|
Social History
|
|
|
Marital Status
|
Pack years
|
|
Living Arrangements
• • •
|
Caffeine
|
|
Substance use
• • •
|
Comments
|
|
Diet
• • •
|
Comments
|
|
DNR
|
Past Occupation
|
|
|
|
|
Area Patient Lives:
|
|
|
Medical Care Team:
|
|
|
Medical Care Team (Genesee County)
|
|
|
Rosehaven
|
|
|
Primary & Palliative Care
|
Palliative Care Only
|
|
Multi-Select (PCP)
• • •
|
|
|
Preferred Skilled Care (The Care Team)
|
|
|
Podiatrist (Multi-select)
• • •
|
|
|
Cardiology
|
Cardiologists
• • •
|
|
Gastroenterology
|
Gastroenterologists
• • •
|
|
Neurology
|
Neurologists
• • •
|
|
Endocrinology
|
Endocrinologists
• • •
|
|
Pulmonology
|
Pulmonologists
• • •
|
|
Dermatology
|
Dermatologists
• • •
|
|
Infectious Disease
|
Infections disease MDs
• • •
|
|
Urology [Empty]
|
Urologists
• • •
|
|
Spinal Surgery
|
Spinal MDs
• • •
|
|
Pain mgmt
|
Pain Doctors
• • •
|
|
Medical Care Team (Livingston County)
|
|
|
Village Manor
|
|
|
Woodland Village
|
|
|
Hidden Creek
|
|
|
PCP & Palliative (TCS Housecalls)
|
|
|
Other PCP
|
Other PCP (multi select)
• • •
|
|
Podiatrist
|
Podiatrist (Multi-select)
• • •
|
|
Skilled Care (The Care Team)
|
|
|
Cardiology
|
Cardiologists
• • •
|
|
Gastroenterology
|
Gastroenterologists
• • •
|
|
Endocrinology
|
Endocrinologists
• • •
|
|
Neurology
|
Neurologists
• • •
|
|
Pulmonology
|
Pulmonologists
• • •
|
|
Dermatology
|
Dermatologists
• • •
|
|
Infectious Disease
|
Infectious Disease MDs
• • •
|
|
Urology [Empty]
|
Urologists
• • •
|
|
Spinal Surgery
|
Spinal Surgeons
• • •
|
|
Pain Mgmt (Empty)
|
Pain Mgmt MDs
• • •
|
|
Medical Care Team (Oakland County)
|
|
|
PCP & Palliative (TCS Housecalls)
|
Other PCP
|
|
Multi-Select (PCP)
• • •
|
|
|
Podiatrist (Multi-select)
• • •
|
|
|
Skilled Care (The Care Team)
|
|
|
Cardiology
|
|
|
Gastroenterology
|
|
|
Endocrinology
|
|
|
Neurology
|
|
|
Pulmonology
|
|
|
Dermatology
|
|
|
Infectious Disease
|
|
|
Infectious Disease
|
|
|
Urology [Empty]
|
|
|
Spinal Surgery (Tsu)
|
|
|
Pain Mgmt (Empty)
|
|
|
|
|
|
PCP & Palliative (TCS Housecalls)
|
Other PCP
|
|
Podiatrist (Multi-select)
• • •
|
Podiatrist (Multi-select)
• • •
|
|
Skilled Care
|
|
|
|
|
|
Family History
|
|
|
Father's MH
• • •
|
|
|
Mother's MH
• • •
|
|
|
Sibling(s)' MH
• • •
|
|
