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Chronic Care Worksheet
Nov 4, 2019
•
Mark Morgan
categories:
Complete Note
age
y/o male. Intake
intake year
for
admission diagnosis
Past Medical History:
speech input
past medical history
Surgical History:
speech input
surgical history
Social Hx:
1. Tobacco:
tobacco
2. Alcohol:
alcohol
3. Substances:
substances
4. Tattoos:
tattoos
5. Transfusions:
transfusions
6. Hx STDs:
STDs
7. Sexual Hx:
sexual history
Family Hx:
1. Father:
father
2. Mother:
mother
3. Brothers:
brothers
4. Sisters:
sisters
5. Sons:
sons
6. Daughters:
daughters
7. Other:
other
Prev Med:
1. Flu:
flu
2. Tdap:
tdap
3. PCV13:
pcv13
4. PCV23:
pcv23
5. Hepatitis B:
hepatitis b
6. PSA:
psa
7. Colon ca:
colon ca
8. AAA:
aaa
Medical Duty Status:
1. Limitations:
limitations
2. Equipment:
equipment
Imaging Concerns:
1. Metal device:
metal devices
2. Contrast allergy:
contrast allergy
3. Claustrophobia:
claustrophobia
Medication Monitoring:
atypical antipsychotics
amiodarone
carbamazepine
digoxin
gabapentin
hydroxychloroquine
lamotrigine
levetiracetam
lithium
methotrexate
oxcarbazepine
phenytoin
pregabalin
topiramate
valproic acid
medication monitoring
EKG:
EKG
PFT:
PFT
Chest Xray:
chest xray
Optometry:
optometry
CBC:
CBC
PT/PTT:
PT/PTT
BMP:
BMP
CMP:
CMP
Magnesium:
Magnesium
Calcium:
Calcium
Lipids:
Lipids
HgbA1c:
HgbA1c
TSH:
TSH
Vitamin D:
Vitamin D
Serum Levels:
Serum Levels
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