|
FM NP / FNP-C NP
|
|
|
|
NOTE (excluded)
|
|
TYPE OF VISIT
• • •
|
|
|
Occupation (He/She is----.)
|
additional (sentence)
|
|
See intake packet, I reviewed everything
|
|
|
Primary reason for care/GOALS--basic synopsis (sentence in patient's words)
|
|
|
CC / HPI / Onset / Better / Worse
|
|
|
SOCIAL PRESCRIBING “Do you sometimes feel left out?”
|
|
|
Current ENERGY LEVEL
/
|
|
|
CIRS Hx of Exposure
|
|
|
Discuss Know Exposures
• • •
|
|
|
Discuss in detail
|
|
|
Notes on length of time in exposure, visible mold, musty smell, known hx of WD
|
|
|
Current Home/ Work Details
|
|
|
|
|
|
ADDITIONAL NOTES
|
|
|
Taking medications as prescribed by others
|
Not on Prescriptive Medications
|
|
UC NP
|
|
|
|
Go to BODY DIAGRAM
|
|
See Paper Intake
|
Go to Med Hx & ROS
|
|
General CC in pt's words " "
|
|
|
RED FLAGS Patient DENIES (e.g. dizziness)
|
|
|
Everyday Life Impact Statements
|
|
|
Location of CC
|
|
|
Onset
• • •
|
Onset Comments (sentence)
|
|
Quality
• • •
|
Quality Comments (sentence)
|
|
Severity
|
Severity Comments (sentence)
|
|
Radiates Yes / No
|
radiates where?
|
|
Frequency
• • •
|
Frequency Comments (sentence)
|
|
Context (symptoms occur when.....)
|
|
|
Duration/status
• • •
|
Duration Comments (sentence)
|
|
Modifying Factors (WORSE)
• • •
|
Worse Comments (sentence)
|
|
Modifying Factors (BETTER)
• • •
|
Better Comments (sentence)
|
|
Associated Systemic Symptoms
• • •
|
Associated Symptoms Comments (sentence)
|
|
|
|
|
Additional Complaints/Concerns
|
|
|
PATIENT GOALS
|
|
|
HBOT NP
|
|
|
|
|
|
See Paper Intake
|
Go to Med Hx & ROS
|
|
General CC in pt's words " "
|
|
|
Previous Treatment / Reliability
|
|
|
Previous Healthcare Providers
|
|
|
Previous Treatment
|
|
|
History Provided by
• • •
|
History provided by (other) list not sentence
|
|
Reliability of history
|
History/ Exam limited by: (sentence)
|
