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TRT
New TRT PT
• • •
Additional notes
New TRT on Testosterone Not Prescribed
• • •
Additional Notes
New TRT on Testosterone Prescribed
• • •
Additional Notes
Start TRT PT After Initial Consult
• • •
Additional Notes
Restart TRT Medical Clearance Not Needed
• • •
Additional Notes
Restart PT Medical Clearance Provided
• • •
Additional Notes
New Clomid Pt
• • •
Additional Notes
New Gonadorelin PT
• • •
Additional Notes
TRT/Clomid Pt
• • •
Additional Notes
Testosterone symptoms tracker
• • •
Excess estrogen symptoms
• • •
Labs Follow up
Testosterone symptoms tracker follow up
• • •
Excess estrogen symptoms
• • •
Routine lab review 4-6 weeks. No issues.
• • •
Routine lab review 4-6 weeks. Complaints
• • •
Routine lab review 2 months. No issues
• • •
Routine lab review 2 month. Complaints
• • •
Routine lab review 3 months. No issues.
• • •
Routine lab review 3 months. Complaints
• • •
Routine lab review 4 months. No issues.
• • •
Routine lab review 4 month. Complaints
• • •
Routine lab review 6 months. No issues.
• • •
Routine lab review 6 months. Complaints
• • •
Repeat labs due to low testosterone
• • •
Repeat labs due to elevated Testosterone
• • •
Labs due to estrogen symptoms
• • •
Follow up Estradiol labs
• • •
Comprehensive lab draw
• • •
Follow up comprehensive labs
• • •
Repeat Abnormal lab draw
• • •
Follow up Abnormal lab draw
• • •
Request for Telehealth Slip
• • •
Erectile Dysfunction Services
Initial ED consult. No prior Treatment.
• • •
Initial ED consult. Prior Treatment.
• • •
Peyronie's Consult
• • •
Repeat Services for ED treatment
• • •
SHIM
• • •
ED time frame
• • •
Trimix Trial injection
• • •
Reorder Medication
• • •
GW session with MA or Provider
GW Session
• • •
Pellet Placement
Pellet Placement
• • •
Low Testosterone Symptoms
• • •
Pellet Incision check
• • •
Peptides
HGH Peptide Sermorelin
• • •
BPC
• • •
CJC
• • •
Neuro-protective peptide
• • •
PT 141
• • •
Sermorelin with Glycine
• • •
Peptide Issues
• • •
PRP
Initial consult PRP
• • •
PRP Procedure
• • •
Semaglutide/Tirzepatide/Phentermine Consult
Semaglutide/Tirzepatide Consult Consult
• • •
Semaglutide/Tirzepatide Consult Telehealth
• • •
Semaglutide/Tirzepatide Start Medication
• • •
GLP1 Reorder. No complaints.
• • •
GLP1 Reorder. Complaints.
• • •
Phentermine consult/refill
• • •
Vitamins
Vitamins
• • •
TRT Issues
Blood Pressure Problems
Elevated Blood Pressure
• • •
Care Terminated for TRT
Care Terminated
• • •
Dose Change
Dose Change
• • •
Elevated Hemoglobin
Elevated Hemoglobin Dose not Held
• • •
Elevated Hemoglobin Dose Held
• • •
Elevated PSA Marker
Elevated PSA Marker
• • •
Hair loss
Hair loss
• • •
Injection Site Change
Injection site change
• • •
Pain
Pain
• • •
Skin Infection
Skin Infection
• • •
Testicle atrophy
Testicle atrophy
• • •
Additional Services
Micro Needling
Microneedling consult
• • •
Neograft Consult/Procedure
Hair consult/Procedure
• • •
NeoGraft Follow up
• • •

H&P CC / History of Present Illness Medical Form

Nurse Practitioner

Rrespress8/27/24

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Published: Aug. 27, 2024, 11:11 a.m.
Doctor: Dr. History Physical
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