|
HPI
|
|
|
Type of Visit
|
Type of Visit Comment
|
|
Visit Location
|
Visit Location Comment
|
|
Past Medical History
• • •
|
PMH Freewrite
|
|
Past Surgical History
• • •
|
Surgical Freewrite
|
|
Social History
|
|
|
Living Arrangements
• • •
|
Living Arrangements Comment
|
|
Tobacco Use Status
|
Alcohol
|
|
PCP/Specialists
|
Home Health
|
|
Preferred Pharmacy
|
|
|
Review of Systems
|
|
|
General [-]
|
General
• • •
|
|
General Comments
|
|
|
Skin [-]
|
Skin
• • •
|
|
Skin Comments
|
|
|
Neurological [-]
|
Neurological
• • •
|
|
Neuro Comments
|
|
|
Psychiatric [-]
|
Psychiatric
• • •
|
|
Psychiatric Comments
|
|
|
MSK [-]
|
MSK
• • •
|
|
MSK Comments
|
|
|
Cardiovascular [-]
|
Cardiovascular
• • •
|
|
CV Comments
|
|
|
Respiratory [-]
|
Respiratory
• • •
|
|
Resp Comments
|
|
|
GI [-]
|
GI
• • •
|
|
GI Comments
|
|
|
Periph. Vasc. [-]
|
Periph. Vasc.
• • •
|
|
Periph. Vasc. Comments
|
|
|
Urinary [-]
|
Urinary
• • •
|
|
Urinary Comments
|
|
|
Endocrine [-]
|
Endocrine
• • •
|
|
Endo Comments
|
|
