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Subjective
History of Present Illness
Past Medical History
Past Surgical History
Previous treatment
Review of Systems
General [-]
General
• • •
General Comments
Skin [-]
Skin
• • •
Skin Comments
Cardiovascular [-]
Cardiovascular
• • •
CV Comments
Respiratory [-]
Respiratory
• • •
Resp Comments
GI [-]
GI
• • •
GI Comments
Urinary [-]
Urinary
• • •
Urinary Comments
Periph. Vasc. [-]
Periph. Vasc.
• • •
Periph. Vasc. Comments
MSK [-]
MSK
• • •
MSK Comments
Neurologic [-]
Neurologic
• • •
Neuro Comments
Endocrine [-]
Endocrine
• • •
Endo Comments
Psychiatric [-]
Psychiatric
• • •
Psychiatric Comments
New Patient/Follow-up
Ingrown
Ingrown Follow up
Heel Pain/Plantar Fasciitis
Neuroma
New Patient/Follow-up
Objective
Physical Exam
General
Cardiovascular
Musculoskeletal
Dermatologic
Neurological
Imaging
New Free Draw
New Free Draw
New Free Draw
New Free Draw
New Free Draw
New Free Draw
New Free Draw
Assessment
Plan
Procedure
Ingrown Nail
Objective
Physical Exam
General
Cardiovascular
Musculoskeletal
Dermatologic
Neurological
Assessment
Plan
Avulsion
Matrix
Nail Avulsion
Matricectomy
Ingrown Follow up
Objective
Physical Exam
General
Cardiovascular
Musculoskeletal
Dermatologic
Neurological
Assessment
Plan
Heel Pain/Plantar Fasciitis
Objective
Physical Exam
General
Cardiovascular
Musculoskeletal
Dermatologic
Neurological
Imaging
New Free Draw
New Free Draw
New Free Draw
New Free Draw
New Free Draw
Assessment
Plan
Injection Plan
Medrol Plan
Injection Plan
Steroid Injection
Medrol Plan
Conservative Plan
Neuroma
Objective
Physical Exam
General
Cardiovascular
Musculoskeletal
Dermatologic
Neurological
Imaging
New Free Draw
New Free Draw
New Free Draw
New Free Draw
New Free Draw
Assessment
Plan
Neuroma Injection Plan
Neuroma Conservative Plan
Neuroma injection
Other

IMG (JB) Office Visit Medical Form

Podiatrist

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Published: Aug. 7, 2023, 4:45 p.m.
Doctor: Dr. History Physical
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