|
Otalgia
|
|
|
Location
• • •
|
Fever
|
|
HPI
|
Associated Symptoms/Pertinent Risk Factors
• • •
|
|
History of infection in affected ear(s)
|
Additional Notes
|
|
REVIEW OF SYSTEMS
|
|
|
ENT (Abnormal)
• • •
|
ENT (Normal)
• • •
|
|
Pulm (Abnormal)
• • •
|
Pulm (Normal)
• • •
|
|
Constitutional (Abnormal)
• • •
|
Constitutional (Normal)
• • •
|
|
All systems otherwise negative.
|
Additional
|
|
PHYSICAL EXAM
|
|
|
PE: Superficial (abd/msk deferred)
|
ENT: pharynx: erythematous, otherwise neg
|
|
ENT (Abnormal)
• • •
|
ENT (WNL)
• • •
|
|
Pulmonary (Abnormal)
• • •
|
Respiratory (negative)
• • •
|
|
Cardio-Pulm
|
PHYSICAL EXAM*
|
|
|
Insert PE Macro Here
|
|
MDM
|
|
|
Status:
|
Differential Diagnosis:
• • •
|
|
Status:
|
Final Dx
|
|
Diagnosis:
|
|
|
DISCHARGE
|
|
|
Discharge Date/Time
|
|
|
After Care Instructions
• • •
|
Discharge Instructions
|
|
POC Medications Given
• • •
|
|
|
Disposition--DC Home w F/u Instructions
|
Clinic Visit CPT CODE***
|
|
|
|
|
Discharge Note: ERD ONLY
|
|
