|
|
|
|
Chief Complaint
|
|
|
Current Weight:
|
Goal Weight:
|
|
Current Diet Plan:
• • •
|
Behavioral Intervention:
• • •
|
|
Pharmacotherapy:
• • •
|
Medication Side effects:
|
|
Weight Loss Since last visit
|
|
|
|
|
|
Treatment Plan
|
|
|
Semaglutide
|
|
|
Semaglutide Dosing
|
|
|
Semaglutide associated recommendations
|
|
|
Tirzepatide
|
|
|
Tirzepatide Injection Recommentations
|
|
|
Provider comments:
|
Medication side effects comments:
|
|
General Instructions:
• • •
|
General instruction comments:
|
|
Diagnosis:
• • •
|
|
