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FOLLOW-UP NOTES
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DISCHARGE SUMMARY
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In-Home Visit & Consent?
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In-home Covid-19 Screening Questions last 48 hours
• • •
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Virtual session & Consent
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Patient Location Address & County at time of Virtual Session
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Where was the patient during the virtual session?
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Diagnosis (do not include ICD codes)
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Sessions completed
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# of Cancellations
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# of No Shows
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Subjective:
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Notes
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Current Verbal Numeric Pain Rating Scale
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Patient reported % improvement
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Objective:
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Notes
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Discharge Outcomes
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Current Verbal Numeric Pain Rating Scale
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% Overall Improvement
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Pain at Best (0-10) & Type
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Paint at Worst (0-10) & Type
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MSK-HQ initial evaluation
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MSK-HQ discharge
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Free text outcomes at discharge
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Interventions & Time
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Notes
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Assessment:
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Notes
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Discharge Assessment
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Short Term Goal #1
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Goal Status
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Short Term Goal #2
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Goal Status
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Short Term Goal #3
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Goal Status
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Long Term Goal #1
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Goal Status
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Long Term Goal #2
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Goal Status
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Long Term Goal #3
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Goal Status
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SOAP Plan (Include Freq/Duration & Treatment)
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Notes
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Billing can be found in the H&P and SOAP sections
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Discharge Plan
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Discharge Plan
• • •
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Discharge plan free text
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Reason for Discharge
• • •
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% care plan completed if not fully completed
• • •
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