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CC:
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Experiencing shortness of breath or double breathing?
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Abdominal Pain
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Chest Pain
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Extreme Fatigue or Ill Feelings
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Rash
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Strange Sound when Breathing In/Out
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Unintentional Weight Loss
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Urinating once or less <24 Hrs
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Vomiting or Severe Nausea
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Length of Present Illness in Days
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Cough
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Fever or Chills
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Body Aches
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New Multiple Select
• • •
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Highest Temperature
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Did you get Flu Vaccine this year?
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Recent sick contact
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Smoke cigarettes or another tobacco
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Traveled Out of State (3 Weeks)
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Tried treatment for current symptoms
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Immunosuppressive condition
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PAST MEDICAL HISTORY
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Any Medical Conditions
• • •
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Other information gathered/shared
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ROS
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General [-]
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Skin [-]
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HEENT [-]
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Neck [-]
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Cardiovascular [-]
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Respiratory [-]
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GI [-]
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Periph. Vasc. [-]
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Endocrine [-]
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Psychiatric [-]
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INPATIENT OFFICE VISIT EXAM
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General WNL
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General Abnormal
• • •
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HEENT WNL
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HEENT Abnormal
• • •
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Skin WNL
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Skin Abnormal
• • •
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Neck WNL
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Neck Abnormal
• • •
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Cardiovascular WNL
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Cardiovascular Abnormal
• • •
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Lungs WNL
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Lungs Abnormal
• • •
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Breast Exam Performed?
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Breasts WNL
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Breasts Abnormal
• • •
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Abdomen WNL
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Abdomen Abnormal
• • •
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Male Exam Performed ?
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Genital (Male) [-]
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Genital Abnormal (Male)
• • •
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FEMALE EXAM PERFORMED
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Genital (Female) [-]
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Genital Abnormal (Female)
• • •
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Bimanual Choices
• • •
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Pelvic Choices
• • •
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Neuro WNL
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Neuro Abnormal
• • •
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MSK [-]
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MSK
• • •
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Extremities WNL
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Extrem Abnormal
• • •
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Assessment
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