Patient Notes

Date:
Student Name:
Patient Number:
   
HISTORY – Include significant positives and negatives from history of present illness, past medical history, review of system(s), social history, family history, medications and allergies.

 


PHYSICAL EXAMINATION

DIFFERENTIAL DIAGNOSIS - In order of likelihood (with 1 being the most likely), list up to 5 potential or possible diagnoses for this patient's presentation (in many cases, fewer than 5 diagnoses are likely):
1.
2.
3.
4.
5.
DIAGNOSTIC WORKUP - List immediate plans (up to 5) for further diagnostic workup:
1.
2.
3.
4.
5.
 

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