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Chief Complaint
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Consent
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History of Present Illness
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Review of Systems
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General- Patient Denies
• • •
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General- Patient Confirms
• • •
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General Text Field
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Eyes- Patient Denies
• • •
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Eyes- Patient Confirms
• • •
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Eyes Text Field
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Ears/Nose/Mouth/Throat- Patient Denies
• • •
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Ears/Nose/Mouth/Throat- Patient Confirms
• • •
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Ears/Nose/Mouth/Throat Text Field
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Cardiovascular- Patient Denies
• • •
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Cardiovascular- Patient Confirms
• • •
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Cardiovascular Text Field
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Respiratory- Patient Denies
• • •
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Respiratory- Patient Confirms
• • •
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Respiratory Text Field
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Gastrointestinal- Patient Denies
• • •
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Gastrointestinal- Patient Confirms
• • •
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Gastrointestinal Text Field
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Genitourinary- Patient Denies
• • •
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Genitourinary- Patient Confirms
• • •
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Genitourinary Text Field
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Musculoskeletal
• • •
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Musculoskeletal Text Field
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Skin- Patient Denies
• • •
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Skin- Patient Confirms
• • •
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Skin Text Field
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Heme/Lymph- Patient Denies
• • •
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Heme/Lymph- Patient Confirms
• • •
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Heme/Lymph Text Field
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Immunologic Text Field
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Neurological- Patient Denies
• • •
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Neurological- Patient Confirms
• • •
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Neurological Text Field
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Psychiatric- Patient Denies
• • •
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Psychiatric- Patient Confirms
• • •
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Psychiatric Text Field
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Exercise Text Field
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Sleep Text Field
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Past Medical & Surgical History
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Past Medical & Surgical History
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Family History
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Family History
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Social History
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Social History
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Allergies
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Allergies
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Medications
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Medications
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PHYSICAL EXAMINATION
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Physical Examination
• • •
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Text Field
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Vitals
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General
• • •
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Text Field
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Eyes
• • •
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Text Field
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Pulmonary
• • •
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Text Field
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Skin
• • •
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Text Field
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Musculoskeletal
• • •
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Text Field
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Neuro/Psych
• • •
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Text Field
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LABS
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Lab Data
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IMAGING
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Imaging Data
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DIFFERENTIAL DIAGNOSIS
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Differential Diagnosis
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ASSESSMENT
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Assessment Field
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PLAN
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Plan Field
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Dr. Lazar's Signature
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Time Spent
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Time Spent Statement- 70 Minutes
|
Time Spent Statement- 60 Minutes
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