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Who is collecting this info?
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STAFF
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HOSPITALIZATION
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POST-HOSPITALIZATION?
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Admission/Discharge Diagnosis
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Hospital Name
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Hospitalization Discharge Date
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Days in Hospital
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Discharged to...
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NARRATIVE SUMMARY
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Open NARRATIVE
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Open ADDITIONAL>>>HPI 2, HPI 3 for more problems
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CHRONIC ILLNESS
• • •
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CURRENT 1st PROBLEM ("Patient complains of...")
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CHANGES FROM LAST VISIT?
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Any CHANGES from last visit?
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1st PROBLEM
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ONSET
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Open ONSET
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ONSET
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onset pattern...
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Onset Comments
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LOCATION
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Open LOCATION
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LOCATION
• • •
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location specific...
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Location Comments
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DURATION
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Open DURATION
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DURATION
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...lasting per episode...
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Duration Comments
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CHARACTERISTICS
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Open CHARACTERISTICS
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CHARACTERISTICS
• • •
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Also described as...
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AGGRAVATING
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Open AGGRAVATING
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AGGRAVATING
• • •
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and WORSE...
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AGGRAVATING Comments
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TIMING
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Open TIMING
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TIMING
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TIMING Comments
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SEVERITY
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Open SEVERITY
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SEVERITY
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SEVERITY Comments
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ASSOCIATED SYMPTOMS
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Open ASSOCIATED SYMPTOMS
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ASSOCIATED SYMPTOMS
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Associated Symptoms Comments
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PREVIOUS TREATMENT
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Open PREVIOUS TREAMENT
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PREVIOUS TREATMENT for this problem
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COURSE
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Open COURSE
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COURSE / IMPROVEMENT
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Don't Use
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HAIR, SKIN, NAIL PROBLEM
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HEAD AND NECK PROBLEMS
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RESPIRATORY PROBLEMS
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CARDIOVASCULAR PROBLEMS
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MUSCULOSKELETAL PROBLEMS
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GASTROINTESTINAL PROBLEMS
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IMMUNE & ENDOCRINE PROBLEMS
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GENITOURINARY PROBLEMS
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