SORE THROAT
VIRAL/BACTERIAL URI
Encounter Form
Patient Name __________________________________________________________________ DOB ______________
Statement of Incident_______________________________________________________________________________
ALLERGIES _________________________Current Medications _______________________ LMP _______________
Temp _______________ B/P _______________________________ Pulse ___________________ Resp __________
ASSESSMENT:
Yes No Contact with anyone who’s been ill
Yes No Positive Kernig’s Sign, meningeal irritation noted.
Yes No Headache
Yes No Conjunctivitis
Yes No Tender maxillary sinuses
Yes No Nasal drainage/Rhinorrhea Type ______________ Severity _________
Yes No Tender, enlarged anterior cervical lymph nodes Severity: ___________________
Yes No Tonsilar exudate or enlargement Severity: _______________________________
Yes No Red throat Severity: _____________________________________________
Yes No TM’s Abnormal Describe _____________________________________________
Yes No Cough: Productive, Describe ______________ Nonproductive Hoarseness
Yes No Lung sounds abnormal Describe ______________________________________
Yes No Abdominal pain, upset stomach, nausea or vomiting
Yes No Scarlatina rash
STANDING ORDER:
Yes No Rapid Strep: Results __________(neg) Manufacturer ____________________ Sent to lab? _________
Lot # ________________ Expiration date _________________ Performed by ____________________
TREATMENT: Yes No
Yes No Reassurance ___ Tobacco use
Yes No Increase fluid intake ___ Weight management
Yes No Warm saline gargles ___ Injury prevention
Yes No Tylenol 325 mg tabs x 2 or Advil 200-400mg x 1 dose ___ Drinking/Drug use
Yes No Cepacol lozenge ___ School Attendance
Yes No Robitussin PE cough syrup 5-10 cc ___ School performance
Yes No Sudafed 30–60 mg ___ Physical Activity
Yes No Prescription given _____________________________ ___ Sexual behavior
Yes No Stable ___ IZ's current
REFFERAL: MD NP PCP
D/C Instructions Given: Yes No
Return to Class Yes No Adult Parent Notified (Time) __________________ RTC _________________
RN _________________________________________ MD/NP ________________________________________
FOLLOW UP
DATE __________________________ TIME _________________
NOTES: _______________________________________________________
___________________________________________________
___________________________________________________
______________________________________________________________
PROVIDER ____________________________________________________
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- base test croc 2 ua
- recommendations for cross sectional imaging in
- abdominal retroperitoneal lymphadenopathy in an
- clinical significance of regional lymph node enlargement
- unexplained lymphadenopathy evaluation and
- hematology lecture notes
- melanoma case scenario 1
- ch 21 diseases of the respiratory tract
- improving care in ed a quality initiative by the
- gastrotraining
Related searches
- best sore throat medication
- best otc sore throat medicine
- tea for sore throat and cough
- best medicine for sore throat and cough
- home remedy for sore throat and cough
- how to cure a sore throat overnight
- sore throat swollen glands no fever
- natural sore throat remedies
- icd 10 code for sore throat unspecified
- icd 10 sore throat unspecified
- viral sore throat icd 10
- sore throat icd code