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La Cañada Medical Group
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HPI
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ROS
• • •
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Medication List:
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General WNL
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General Abnormal
• • •
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General Comments
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HEENT WNL
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HEENT Abnormal
• • •
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HEENT Comments
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Skin WNL
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Skin Lesion
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Skin Comments
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Neck WNL
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Neck Abnormal
• • •
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Neck Comments
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Cardiovascular WNL
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Cardiovascular Abnormal
• • •
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Cardiovascular Comments
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Lungs WNL
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Lungs Abnormal
• • •
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Lungs Comments
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Abdomen WNL
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Abdomen Abnormal
• • •
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Abdomen Comments
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MSK WNL
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MSK Abnormal
• • •
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MSK Comments
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Breasts WNL
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Breasts Abnormal
• • •
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Breasts Comments
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Neuro WNL
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Neuro Abnormal
• • •
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Neuro Comments
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Extremities WNL
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Extrem Abnormal
• • •
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Extrem Comments
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Diagnosis
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Diagnosis
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Plan
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Plan
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Vaccine and Date Received
• • •
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Date
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Preventative Care and Referrals
• • •
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Other
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New RX Orders
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Labs
• • •
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Lab Comments
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Radiology
• • •
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Radiology Comments
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PT Recommendations
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PT Recommendation Comments
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Home Health
• • •
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Home health comments
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Referrals Auth Required
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Referral Comments
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Education
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Education Comments
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Diet
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Diet Comments
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General Instructions
• • •
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General Instruction Comments
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POLST
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Family/POA
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Next Office Visit
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Notes
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