Where did you find us?
|
(if other source)
|
Insert notes from nurse triage, if available
|
HPI
|
PMH Dropdown
• • •
|
Additional Past Medical HX
|
Family HX
|
Social HX
|
General ROS
• • •
|
General Comments
|
LMP (For UTI, Etc)
|
Reminder: complete MEDS & Allergies of SOAP
|
Available objective information:
|
Photographs transferred from app:
|
|
Reminder: Choose ICD:10 code in SOAP Assesment
|
|
|
General Instructions
• • •
|
General Instruction Comments
|
Referred to ER STAT
|
Patient strongly preferred antibiotic treatment
|
Notes to follow up nurse:
• • •
|
Additional notes for follow up:
|
Patient was signed over to another clinician
|
Person to whom patient was endorsed:
|
Working diagnosis or R/O
|
Type of visit expected of receiving clinician:
|
Time of expected visit
|
Stat Imaging Pending:
|
Stat labs pending:
|
Other expected service pending:
|
Labs for nurse collection:
• • •
|
Actions required: If study is positive
|
Actions required: If study is negative
|
Time of Sign Out:
|
Method of Sign Out
|
Additional transfer of care notes:
|
Changes to service location or contact info
|
|