PROGRESS NOTES



PROGRESS NOTES

ATLANTA WOMEN’S SPECIALTY GROUP | |

ALLERGIES:_______________________________________

Patient’s Name: __________________________________ DOB: _________ Age: ________ Date: ___________________________

HT: ________ WT: ___________ TPR: / / BP: / ( NKDA_______________ Urine:______ UPT:_________

LMP: ____________ Hysterectomy? ______________________________________

|MEDICATIONS |SUPPLEMENTS |

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| |( See NPI form for HPI & complete M,F,S Hx |

CHIEF COMPLAINTS:

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Page 2---------------------------------------------------------Name of Patient: _____________________________________________________

REVIEW OF SYSTEMS

CHECK indicates normal, X, indicates abnormal

| |Constitutional | |ENT | |Respiratory |

| |Psychiatric | |GI | |Musculoskeletal |

| |GU | |Endocrine | |Neurological |

| |Skin | |Lymphatic | |All other symptoms negative |

| |Eyes | |Cardiovascular | | |

PHYSICAL EXAM

|SYSTEMS |WNL |ABN |Abnormal |SYSTEMS |WNL |ABN |Abnormal Findings |

| | | |Findings | | | | |

|Constitutional: | | | |Skin/Breast: | | | |

|Eyes | | | |GI/Abdomen | | | |

|ENT: | | | |GU: | | | |

|Respiratory | | | |Musculoskeletal: | | | |

|Lungs: | | | |Neurological: | | | |

|Cardiovascular: | | | |Psychiatric: | | | |

IMPRESSION /PLAN (Additional notes to the back of this page)>>>>>>

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( Counseling: Total face-to-face time: _________ Total time counseling: ________ (must be greater than 50% of total face to face time)

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TOPICS DISCUSSED: ________________________________________________________________________________________________________________

| |( CV ASSESSMENT | |LAB REVIEW |

|99213-15 |Cc, HPI-1, ROS |2-7 systems |2 stable problems |1 unstable problem |

|99214-25 |Cc, HPI-4, ROS-2, Med Hx |2-2 systems (4x2) |3 chronic stable dx (RX) |1 chronic disease (RX) & 1 chronic unstable |2 unstable (RX) |

| | | | |disease (RX) | |

|99203-30 |Cc, 4HPI, ROS-2, Med Hx |2-7 systems (4x2) |Over the Counter Drugs |Short Antibiotics/Meds |Minor Surgery |

|99204-45 |Cc, 4HPI, ROS-10, M,F,S Hx |8 systems |Prescription Drugs |Undiagnosed New Problem Uncertain Prognosis |Minor Surgery |

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