|
HPI
|
|
|
HPI comments
|
|
|
FIRE HPI
|
No concerns
|
|
FIRE HPI comments
|
|
|
Initial Consult Weight history
|
|
|
Med interest
• • •
|
Interest in meal replacements
• • •
|
|
Interest in surgery
|
Confidence in losing weight
• • •
|
|
Foods can't eat
|
|
|
F/u Weight hpi
|
|
|
Last Done
|
|
|
Physical/AWV
|
|
|
Mammogram
• • •
|
|
|
PAP
• • •
|
|
|
PSA
• • •
|
|
|
Colon Cancer Screen
• • •
|
|
|
Lung Cancer Screen 50-80 yo 20 pack yr/quit w/in 15 years
• • •
|
|
|
DEXA
• • •
|
|
|
Hep C screen (adults 18-79yo)
• • •
|
|
|
HIV screen (adults 15-65yo)
• • •
|
|
|
AAA Screen (men 65-75yo w/ h/o smoking)
• • •
|
|
|
Flu Vaccine
• • •
|
|
|
COVID Vaccine
• • •
|
|
|
Shingles Vaccine
• • •
|
|
|
Pneumonia Vaccine
• • •
|
|
|
Td/Tdap
• • •
|
|
|
RSV Vaccine
• • •
|
New Short Text Field
|
|
Other Vaccines
|
|
|
Recent Hospital Visit
• • •
|
|
|
Specialists
|
|
|
Allergist/Immunologist
|
Comments
|
|
Cardiology
|
|
|
Dermatology
|
|
|
Endocrinology
|
|
|
ENT
|
|
|
EP
|
|
|
GI
|
|
|
Hem/Onc
|
|
|
ID
|
|
|
Nephro
|
|
|
Neuro
|
|
|
Neurosurgeon
|
|
|
OB/GYN
|
|
|
Ophtho
|
|
|
Ortho
|
|
|
Pain Mgmt
|
|
|
Podiatry
|
|
|
Pulm
|
|
|
Psychiatrist
|
|
|
Psychologist
|
|
|
Rheum
|
|
|
Surgeon, General
|
|
|
Surgeon, Plastic
|
|
|
Urology
|
|
|
Urogyn
|
|
|
Last PCP
|
|
|
|
|
