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History of Present Illness
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Pertinent Past Medical History
|
|
Family History
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Pertinent Past Surgical History
|
|
Smoking status
|
Alcohol
|
|
Drug Use
• • •
|
Pattern of Drug Use
• • •
|
|
REVIEW OF SYSTEMS
|
|
|
ROS ALL NEGATIVE
|
|
|
ROS (add any PT "Denies" ROS comments)
|
ROS (add any "Complains of" ROS remarks)
|
|
PHYSICAL EXAM
|
|
|
General WNL
|
General
|
|
Skin WNL
|
Skin
|
|
MSK WNL
|
MSK
|
|
Pulses WNL
|
Pulses
|
|
Extremities WNL
|
Extremities
|
|
Neurologic WNL
|
Neurologic
|
|
Wound Size as recorded in custom vitals
|
Wound Description
|
|
Assessment and Plan [text]
|
Lymphedema Pump Recommended-
|
|
Exam Follow Up
• • •
|
Exam Follow Up - Other [text]
|
|
General Instructions
• • •
|
General Instruction/Recommendation [text]
|
|
Non Invasive Vascular Lab Studies
• • •
|
Non Invasive Vascular Lab Studies [text]
|
|
Radiology
• • •
|
Radiology [text]
|
|
Leg Measurements- both legs
|
|
|
Below the knee- Right
|
|
|
Calf- Right
|
|
|
Ankle- Right
|
|
|
Below the knee- Left
|
|
|
Calf- Left
|
|
|
Ankle- Left
|
|
