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Reason for Visit:
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Turn ON if NEW PATIENT
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Turn ON if EXISTING PATIENT
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HPI (New Patient)
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Update Since Last Encounter
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Enter any change to patient's history or status below:
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Updates to Medical History:
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Pregnant?
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Breast Feeding?
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Current Medications
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Drug Allergies
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Legal History
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Social History
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Psychiatric History
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Substance Abuse History
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Family Psychiatric History
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Review of Systems, Active Medical Problems and Comorbidities (Note if positive)
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Constitutional
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Eyes
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Ears/Nose/Mouth/Throat
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Cardiovascular
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Respiratory
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Gastrointestinal
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Musculoskeletal
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Integumentary
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Neurological
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Endocrine
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Hemotologic/Lymphatic
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Allergies/Immune
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Review of Systems Positive Details:
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Documentation / Treatment Plan
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Documentation Reviewed
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Details/Other:
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Medication Adjustments
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Benefits, Side Effects, and Risks of Medications discussed with patient?
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Psychoeducation Provided:
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Consent from Patient/Guardian given?
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Treatment Plan
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Out of House Orders for Procedures and Labs
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Other:
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Level of Risk
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Treatment Administration Dates
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Date of last Waist Circumference:
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Date of last SLUMS:
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Date of last AIMS:
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Date of Last Labs:
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Date of last MPDR:
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Date of last SBIRT:
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Date of last Pharmacogenomics testing:
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Date of last neurocognitive testing:
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Date of last CRAFT:
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Date of last Falls Assessment:
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Setting
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Patient Status
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Total Time spent with patient:
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Nursing note completed by:
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