|
HPI
|
|
|
Onset
• • •
|
Course
• • •
|
|
Severity
|
Location
• • •
|
|
Description of Injury:
• • •
|
Fever?
|
|
MEDICAL DECISION MAKING
|
|
|
MDM
|
|
|
Procedure Attestation ***
|
|
|
Anesthesia: ***
|
|
|
Location of foreign body:
|
|
|
Slit lamp exam ***
|
Wood's lamp***
|
|
Exam findings:
• • •
|
Exam findings:
|
|
Instrument used for removal: ***
|
Instrument used for removal: ***
|
|
FB removed successfully without complications
|
Notes:
|
|
Visual acuity: Right 20/__
|
Left - 20/__
|
|
Correction
|
Notes:
|
|
PHOTO
|
PHOTO
|
|
DISCHARGE
|
|
|
POC Medications Given
• • •
|
|
|
Plan Notes
|
|
|
Discharge pt home
|
Discharge pt to ER
|
|
|
Mode of Transport to ER
|
|
|
ER Transfer Comments
|
|
Clinician Attestation
|
|
