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Reviewed Past Medical History?
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Reviewed Home Medications & Alergies?
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LMP - If applicable
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HPI
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Review of Systems
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Review of Systems
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General
• • •
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Reason for visit
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HEENT
• • •
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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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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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Genital (Female) [-]
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Genital (Female)
• • •
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Genital (Female) Comments
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MSK [-]
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MSK
• • •
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MSK Comments
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Neurological [-]
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Neurological
• • •
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Neuro Comments
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Psychiatric [-]
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Psychiatric
• • •
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Psychiatric Comments
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ROS Notes
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Telemedicine Physical Exam
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Normal visual only
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Alert & Oriented x3, Normal LOC, Nourished, Normal Affect, No Apparent Distress
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Skin WNL - No Rash, Lumps, Sores, or Discoloration
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Skin Exam Notes
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HEENT WNL - Normocephalic. No Discharge From Eyes/Ears/Nose, No Discoloration of Sclera, No Mouth Sores, No Swelling
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HEENT Exam Notes
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Musculoskeletal WNL - No Deformities, Stiffness, Swelling, or Redness. Normal Range of Motion.
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Musculoskeletal Exam Notes
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Respiratory WNL - No Accessory Muscle Use, Cough, Dyspnea, or Audible Wheezing
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Respiratory Exam Notes
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Neurologic WNL - No Confusion, Paralysis, Involuntary Movement, or Cranial Nerve Deficits. Normal Coordination
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Neurological Exam Notes
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Psychiatric WNL - No Suicidal or Homicidal Ideations, Normal Mood/Affect, Normal Behavior
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Psychiatric Exam Notes
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Physical Exam Notes
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video
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telephone
|
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99212
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99441 (5-10 min)
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99213
|
99442 11-20 min
|
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99214
|
99443 21-30 min
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Time of visit
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