Allergy Consultants
Patient Report
8/31/16 1:11 PM
Date of Last Visit: [LAST_DOS]
Date of Last Triage: [TRG.DATE]
Patient:
Name:[PT_NAME] ID#: [PT##] DOB: [PT_DOB]
Age:[AGEB] Gender: [PT_SEX] [PT_CITY]
Referring Doctor: [REF_BY]
NOTES: [PMRS.FLAGS]
Chief Complaint and History of Present Illness:
HPI: [HPI.Subjective:]
Plan:
Recall in [EXAM.Follow Up :]
Past Medical History:
Hospitalizations: [PMH.Hospitalizations:]
E.R. Visits: [PMH.E.R. Visits:]
Medical: [PMH.Medical:]
Surgeries: [PMH.Surgeries:]
Allergic/Adverse Food Reactions: [PMH.Advers/Allergic Food Reactions:]
Adverse Drug Reactions: [PMH.Adverse Drug Reactions:]
Latex Sensitivity: [PMH.Latex Sensitivity:]
Insect Sting: [PMH.Insect Sting:]
Skin Testing:
IDST: [ID10.Results Summary:@*]
IDST: [ID12.Results Summary:@*]
IDST: [IDC.Results Summary:@*]
Spirometry/Pulmonary Function Testing
Diagnoses:
Medications:
Triage:
Labs/Procedures:
Date: [CT.month], [CT.year]
X Rays: [XRAY.Xray]
Date: [XRAY.month], [XRAY.year]
Labs: [LABS.|]