Joe's H and P Form

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H and P Form

Joe

Original Start Date: October 2, 2005

H and P Form will create an admission note for an initial patient encounter. It's supposed to be used for a history and physical. The idea is to add more fields so they can be used as individual data points for research later. Future plans include the ability to post history and physicals to blogs or websites for learning purposes, and more analysis of lab values.

To publish a history and physical online, sign up for a blog account at a site such as Blogger.com. Then copy and paste the result of this generator into the HTML field of the publisher. To search through other history and physical on blog sites, try Google's Blog Search.

I'd appreciate any comments or suggestions.

Thanks,
Joe

Table Properties

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Header Properties

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Text Properties

Weight: Color: Background Color:

Description

CC:

HPI:

Past Medical History:

Past Surgical History:

Medications

Immunizations

Allergies

Family History

Social History

Review of Systems

General: () weight loss () fever () night sweats () weakness/fatigue () appetite Endocrine: () heat intolerance () decreased energy () thyroid/reanl dz () polydipsia () polyuria Lympatics: () lymphadenopathy Skin: () itching () pale () palmar creases Hematology: () anemia () bruising () bleeding Head: () seizures () trauma () loss of conscioussness () headache () vertigo () dizziness Eyes: () visual changes () blurred vision () loss of vision () discharge Ears: () discharge () ear pain () tinnitus () ototoxic drug history () hearing loss Nose: () discharge () rhinorrhea () epistaxis Mouth and Throat: () lip cracking () gum soreness () gum hypertrophy () dryness () thirst () excessive salivation () throat pain () hoarseness Cardiorespiratory: () SOB () valvular disease () orthopnea () dyspnea on exertion () nocturia () edema () paroxysmal nocturnal dyspnea () cough () cyanosis () hemoptysis Gastrointestinal () dysphagia () abdominal pain () vomiting () hematemesis () melena () hematochezia () change in appetite () diarrhea () constipation () jaundice Genitourinary: () change in bladder function () change in amount () dysuria () hematuria () discharge Neuropsychiatric: () weakness () motor/sensory deficit () depression () anxiety Pain:

Physical Exam

General Appearance: Vital Signs: Temperature: Oxygen Saturation: Blood Pressure: Respiratory Rate: Pulse Rate: Skin/Nails: Head: Eyes: Ears: Nose: Throat/Mouth: Neck: Lymph: Pulmonary: CV: Abdomen: Breasts: Rectal: Genitals: Peripheral pulses: Musculoskeletal: Neurologic: Mental Status CN I CN II CN III,IV, VI CN V, VII CN VII CN VIII CN IX, X CN XI CN XII Cerebellar DTRs

Labs

Chem 8

Na: Cl: BUN: Glucose:

K: CO2: Cr: Ca:

CBC

WBC: Hgb:
Hct: Plt:
MCV:

Coags

PT: PTT:
INR:

Assessment/Plan

Final:

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