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Driving License

‍‍HISTORY: 
‍‍Presents for a driving license assessment
‍‍Required because of: ‍﻿ ‍﻿﻿
‍‍Type of license: ‍﻿﻿
‍‍Current complaints: ‍﻿﻿
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‍‍Past medical history: ‍﻿﻿
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‍‍Medications: ‍﻿ ‍﻿, ‍﻿﻿
‍‍Adverse effects: ‍﻿ ‍﻿﻿
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‍‍Social history:
‍‍Smoking: ‍﻿, ‍﻿ pack-years
‍‍Alcohol: ‍﻿, ‍﻿ drinks per ‍﻿﻿
‍‍Recreational drugs: ‍﻿ ‍﻿, ‍﻿﻿
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‍‍EXAM: 
‍‍General appearance: ﻿
‍‍Vital signs: ‍﻿, BP ‍﻿, HR ‍﻿, RR ‍﻿, SpO2 ‍﻿ %, Temp ‍﻿°
‍‍Eyes: -R: , -L: , ‍﻿﻿
‍‍Ears: -R: , -L: ﻿
‍‍Neck: ﻿
‍‍Heart: , ﻿
‍‍Lungs: , ‍﻿﻿
‍‍Abdomen: ,  ‍﻿, , ‍﻿﻿
‍‍Musculoskeletal: joints ‍﻿ ‍﻿, ‍﻿﻿
‍‍Neurologic: cranial nerves , strength , sensation , reflexes , cerebellar function , gait ﻿
‍‍Mental status: , , speech , mood , thought process , , judgment ﻿
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‍‍ASSESSMENT: 
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‍‍PLAN: 
‍‍- Vision test
‍‍- Hearing test
‍‍- Cognitive assessment
‍‍- Reassessment of medications that may impair driving
‍‍- Referral to optometrist
‍‍- Referral to audiologist
‍‍- Referral to neurologist
‍‍- Referral to occupational therapist
‍‍- Driving license form filled
‍‍- Follow-up in ‍﻿ ‍﻿﻿