History Templates
Treatment compliance/adherence: Height: Weight: No weight loss, appropriate weight gain. HR & BP: Normal How are your symptoms: How is your mood?: SH: Denies smoking, alcohol, drug use. Stable family social and financial support. No family stressors. FH: No...
History Templates
-Mechanism of injury: -On anticoagulants?: No -Hx of coagulopathy?: No -History of previous concussions?: No Symptoms -Headaches: -Dizziness: -Confusion: Patient endorses headaches, dizziness, and confusion. -No Neck pain/ cervical spine injury. -No LOC. -No red flags...
History Templates
Onset: Discharge?: Pruritus?: Pain / dyspareunia:? Menopausal?:____ Denies: Abd pain, fever/chills, dysuria, frequency, urgency, hesitancy, suprapubic pain, overactive bladder, urinary incontinence. Denies: use of feminine hygiene products, soaps, detergents,...
History Templates
Onset: Discharge?: Pruritus?: Pain / dyspareunia:? Menopausal?:____ Denies: Abd pain, fever/chills, dysuria, frequency, urgency, hesitancy, suprapubic pain, overactive bladder, urinary incontinence. Denies: use of feminine hygiene products, soaps, detergents,...
History Templates
Hot Flashes (Vasomotor Symptoms) in menopausal or perimenopausal women, History No history of DVT or heart problems. No personal history of breast, uterine, or ovarian cancer. No personal history of breast mass, biopsy, atypia or any abnormal breast pathology. No...
History Templates
Duration of DM (yrs): Last A1C (value & date): ___ DM Medications: ___ Compliance with medications?:___ Compliance with diet, exercise?:____ History of hypoglycemia: None Hx of MI, CVA, PAD: ___ Last dilated retinal exam:__ Last diabetic foot exam:__ Patient:...
