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Telemedicine
|
|
|
Telemedicine Consent Obtained
|
|
|
Platform Used
• • •
|
|
|
Audio Visual Capability
• • •
|
|
|
Provider Location
• • •
|
|
|
Patient Location
• • •
|
|
|
Visit Type
• • •
|
|
|
SUBJECTIVE
|
|
|
Chief Complaint
|
|
|
Chief Complaint
|
|
|
History of Present Illness
|
|
|
ROS
• • •
|
|
|
OBJECTIVE
|
|
|
UDT RESULTS
|
|
|
TEST DATE
|
|
|
UDT Results
• • •
|
|
|
Comments
|
|
|
PHYSICAL MEDICINE UPDATES
|
|
|
Physical Medicine Status Updates
• • •
|
|
|
PHYSICAL EXAMINATION FINDINGS
|
|
|
Physical Exam Findings Summary
|
|
|
Risk Stratification Profile
• • •
|
|
|
Comments
|
|
|
ASSESSMENT AND PLAN
|
|
|
Assessment and Plan 1
|
|
|
Assessment and Plan 2
|
|
|
Assessment and Plan 3
|
|
|
Assessment and Plan 4
|
|
|
Assessment and Plan 5
|
|
|
Follow Up
|
|
|
Follow Up Visit
• • •
|
|
|
Attestation
|
|
|
Scribe
• • •
|
|
