Download Sandra Read, MD Dermatology FOLLOWUP PATIENT

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project

Document related concepts

Neonatal infection wikipedia , lookup

Infection control wikipedia , lookup

Hospital-acquired infection wikipedia , lookup

Onchocerciasis wikipedia , lookup

Transcript 
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__________________________________________________________________
Related documents
Sandra Read, MD, Dermatology NEW PATIENT
Sandra Read, MD, Dermatology NEW PATIENT
Updated Medical History
Updated Medical History
Medical History Questionnaire
Medical History Questionnaire
DermClinic_IntakeForm - Derm Clinic Peterborough
DermClinic_IntakeForm - Derm Clinic Peterborough
New Patient Form
New Patient Form
Pediatric Health History
Pediatric Health History
2. Past Medical History
2. Past Medical History
Home/cell Number: ___________________ Work Number: _________________________ (optional) Email address:
Home/cell Number: ___________________ Work Number: _________________________ (optional) Email address:
School Health Checklist for Parents
School Health Checklist for Parents
Medical History Form
Medical History Form
Endocrinology Clinic New Patient Registration Form
Endocrinology Clinic New Patient Registration Form
Patient History Form
Patient History Form
Raynaud Phenomenon
Raynaud Phenomenon
how do animals protect their skin?
how do animals protect their skin?
Home Instructions after Total Hip Replacement
Home Instructions after Total Hip Replacement
Professor Dr Leena Karina Bruckner
Professor Dr Leena Karina Bruckner
Order Writing Guide
Order Writing Guide
Patient Services - Viewing your Summary
Patient Services - Viewing your Summary
Nominee for NCSCP Co-Chair (2011–2014) Sandra I. Read, MD Dr
Nominee for NCSCP Co-Chair (2011–2014) Sandra I. Read, MD Dr
WATER`S EDGE DERMATOLOGY PATIENT PROFILE
WATER`S EDGE DERMATOLOGY PATIENT PROFILE
Multiple Dermatofibromas
Multiple Dermatofibromas
referral packet - North Texas Behavioral Health Authority
referral packet - North Texas Behavioral Health Authority