|
HPI
|
|
|
Onset (days)
|
|
|
Medications tried with relief
|
Medications tried without relief
|
|
History of UTIs
|
|
|
Comments
|
|
|
Review of Systems
|
|
|
Pertinent Positives
• • •
|
Pertinent Negatives
• • •
|
|
Past Medical History
|
|
|
Past Medical History
• • •
|
Past Medical History Freewrite
|
|
Past Surgical History
• • •
|
Past Surgical History Freewrite
|
|
Alcohol
|
Smoker or Non-Smoker
• • •
|
|
Sexual Hx
|
Drug Use
|
|
Comments
|
|
|
Physical Exam
|
|
|
Main exam WNL
|
|
|
Main exam WNL
|
General Survey
|
|
Normal Findings
• • •
|
Abnormal Findings
|
|
Thorax/Lungs
|
Thorax/Lungs WNL
|
|
Normal Findings
• • •
|
Abnormal Findings
|
|
Cardiovascular
|
Cardiovascular WNL
|
|
Normal Findings
• • •
|
Abnormal Findings
|
|
Abdomen
|
Abdomen WNL
|
|
Normal Findings
• • •
|
Abnormal Findings
|
|
Plan
|
|
|
Urinary Tract Infection
• • •
|
|
|
In-house UA Results
|
|
