PATIENT RECORD

Select the patient type below to complete a pre-filled patient record based upon their reason for visiting today.

COVID-19 Patient



HISTORY OF PRESENT ILLNESS / REVIEW OF SYSTEMS



SYMPTOMS: CHECK ONE FOR EACH POSSIBLE SYMPTOM BELOW








PAST MEDICAL / SOCIAL / FAMILY HISTORY





PHYSICAL EXAM
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



PROVIDER CODING











LAB ORDERS



E & M LEVEL



STD Patient



HISTORY OF PRESENT ILLNESS / REVIEW OF SYSTEMS



SYMPTOMS: CHECK ONE FOR EACH POSSIBLE SYMPTOM BELOW








PAST MEDICAL / SOCIAL / FAMILY HISTORY





PHYSICAL EXAM
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



PROVIDER CODING











LAB ORDERS



E & M LEVEL



Injury Patient



HISTORY OF PRESENT ILLNESS / REVIEW OF SYSTEMS



SYMPTOMS: CHECK ONE FOR EACH POSSIBLE SYMPTOM BELOW








PAST MEDICAL / SOCIAL / FAMILY HISTORY





PHYSICAL EXAM
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



PROVIDER CODING











LAB ORDERS



E & M LEVEL



Check-Up Patient



HISTORY OF PRESENT ILLNESS / REVIEW OF SYSTEMS



SYMPTOMS: CHECK ONE FOR EACH POSSIBLE SYMPTOM BELOW








PAST MEDICAL / SOCIAL / FAMILY HISTORY





PHYSICAL EXAM
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



PROVIDER CODING











LAB ORDERS



E & M LEVEL