Clinic Visit Report/Admissions Form

[jkleinsc]

There is a need to create a printable clinic visit report/admissions form with the following information obtained during a clinic visit:

1. ID
2. First Name
3. Last Name
4. Date of Visit
5. H & P from the visit (minus medical history)
6. chief complaint/reason for visit
7. history of present illness
8. Allergies
9. Medications currently on
10. Vitals
11. Labs results (if performed)
12. X-rays taken (if done)
13. Procedures Planned
14. Scheduled Admissions date (if applicable)
15. Surgery Date (if applicable)
16. Instructions on Admission (labs, x-rays)
17. Notes / Instruction to patient