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COVID-19 Vaccination
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Today body temperature
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Telehealth Visit
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Telehealth: Audio
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Generic New prolonlem
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What is the new main problem?
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Location
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Location Comments
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Onset
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Onset comments
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Timing (when)
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Timing comments
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Duration and Context (last-pattern)
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Duration and context Comments
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Severity
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Severity Comments
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Quality of pain
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Quality Comments
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Course
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Course comm
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Ease with
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worsening with
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Associated symptoms
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Associated Symptoms Comments
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Known Risk factors and Modifiers
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risk factors comm
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Current treatment
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Previous Treatment
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Exposure/Travel history
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Have you travelled outside USA in the last 4 weeks?
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Where?
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Have you travelled outside MI in the last 14 days?
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Where?
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Have you have close contact with lab-confirmed COVID-19 patient in the last 14 days?
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Where?
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Working status
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Working Status comment
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COVID-19 similar symptoms
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Duration
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short problems
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what is the Problem?
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Interval Changes
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Modifier
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Treatment
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FREE text #1
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Free text #2
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Free Text #3
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Free Text #4
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Additional historian
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PFSH
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Labs/Radiology/consultants/medical records
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ROS short NORMAL
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ROS
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General [-]
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General [+]
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General Comments
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Skin [-]
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Skin [+]
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Skin Comments
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HEENT [-]
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HEENT [+]
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HEENT Comments
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Neck [-]
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Neck [+]
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Neck Comments
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Breasts [-]
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Breasts [+]
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Breasts Comments
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Cardiovascular [-]
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Cardiovascular [+]
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CV Comments
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Respiratory [-]
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Respiratory [+]
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Resp Comments
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GI [-]
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GI [+]
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GI Comments
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Urinary [-]
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Urinary [+]
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Urinary Comments
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MSK [-]
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MSK [+]
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MSK Comments
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Genital (Male) [-]
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Genital (Male) [+]
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Genital (Male) Comments
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Genital (Female) [-]
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Genital (Female) [+]
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Genital (Female) Comments
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Periph. Vasc. [-]
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Periph. Vasc. [+]
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Periph. Vasc. Comments
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Neurologic [-]
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Neurologic [+]
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Neuro Comments
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Endocrine [-]
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Endocrine [+]
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Endo Comments
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Psychiatric [-]
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Psychiatric [+]
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Psychiatric Comments
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