|
PMH Reviewed?
|
|
|
Use Onpatient?
|
Enter PMHx?
|
|
Use OnPatient PMHx
|
Enter PMHx
|
|
Use OnPatient PSHx
|
Enter PSHx
|
|
Use OnPatient FHx
|
Enter FHx
|
|
Use OnPatient SHx
|
Enter SHx
|
|
Medical History
|
Medical History
|
|
|
|
|
Past Medical History
• • •
|
Past Medical History Freewrite
|
|
|
|
|
Past Surgical History
• • •
|
PSHx Freewrite
|
|
Notes:
|
|
|
PCP
|
PCP Contact Information
|
|
Family History
|
|
|
|
|
|
|
|
|
|
|
|
Notes:
|
|
|
Family History
|
|
|
Mother's Medical History
• • •
|
Comments
|
|
Father's Medical History
• • •
|
Comments
|
|
Siblings' Medical History
• • •
|
Comments
|
|
Other FHx
|
|
|
Social History
|
|
|
|
|
|
|
Notes:
|
|
Social History
|
|
|
Marital Status
• • •
|
|
|
Alcohol
|
Alcohol Notes:
|
|
Smoking Status
|
Smoking Notes:
|
