Download Sandra Read, MD Dermatology FOLLOWUP PATIENT

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Sandra Read, MD Dermatology FOLLOWUP PATIENT‐ PLEASE FILL OUT TOP 1/2 NAME_________________________________________________DATE__________________________ Email address: If you would like to receive discount coupons, health& practice updates __________________________________________________________________________________ Problem for today’s visit________________________________________________________________ Past treatment & Result ‐ for problem____________________________________________________ Current medications__________________________________________Allergies___________________ Please draw where items of concern are today. THANK YOU CC:__________________________________________________________________________________ PE. FINDINGS__________________________________________________________________________ _____________________________________________________________________________________
_____________________________________________________________________________________
LAB RESULTS_________________________________________________________________________ DIAGNOSIS: 1.___________________________Treatment:___________________________________ ____________________________________________ _____________________________________________ 2._____________________________________Treatment:_________________________________ 3. _____________________________________Treatment:____________________________________ RX: discussed: ABCDE’S, SUN PROTECTION, SKIN CANCER, SKIN SURGERY, WOUND CARE, SIGNS OF INFECTION, BENEFIT/RISKS/ALTERNATIVES OF RX. ALL QUESTIONS ANSWERED RETURN/CALL OFFICE__________________________________________________________________