|
General WNL
|
General Abnormal
• • •
|
|
General Comments
|
|
|
HEENT WNL
|
HEENT Abnormal
• • •
|
|
HEENT Comments
|
Skin Lesion
|
|
Skin WNL
|
Skin findings +
• • •
|
|
Skin Comments
|
Fistula or AV dialysis graft
• • •
|
|
Neck WNL
|
Neck Abnormal
• • •
|
|
Neck Comments
|
|
|
Cardiovascular WNL
|
Cardiovascular Abnormal
• • •
|
|
Radial pulses
• • •
|
Pedal pulses
• • •
|
|
Cardiovascular Comments
|
Implant or device present
• • •
|
|
Lungs WNL
|
Lungs Abnormal
• • •
|
|
Lungs Comments
|
|
|
Abdomen WNL
|
Abdomen Abnormal
• • •
|
|
Abdomen Comments
|
|
|
Genitourinary
|
GU abnormal findings
• • •
|
|
Pelvic exam completed
• • •
|
Prostate exam completed
• • •
|
|
MSK WNL
|
MSK Abnormal
• • •
|
|
MSK Comments
|
Knee exam
• • •
|
|
Shoulder exam
• • •
|
Hip exam
• • •
|
|
Breasts WNL
|
Breasts Abnormal
• • •
|
|
Breasts Comments
|
|
|
Neuro WNL
|
Neuro Abnormal
• • •
|
|
Neuro Comments
|
Semmes
/
|
|
Extremities WNL
|
Extrem Abnormal
• • •
|
|
Extrem Comments
|
|
|
Psychiatric
|
|
|
Psychiatric
|
Admits to +
• • •
|
|
Braincheck Testing done today?
• • •
|
Concerns about memory
|
|
Current Suicidal/Homicidal Ideations
|
Feeling safe at home/school/work
|
