HISTORY OF PRESENT ILLNESS / REVIEW OF SYSTEMS
SYMPTOMS: CHECK ONE FOR EACH POSSIBLE SYMPTOM BELOW
PAST MEDICAL / SOCIAL / FAMILY HISTORY
Due to COVID pandemic if suspicion of exposure is possible providers are required to only initiate contact during physical exam if absolutely medically necessary. Please perform the physical exam below and include commentary in section below. When possible record vitals.
REVIEWED WITH THE PATIENT
E & M LEVEL