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- Note header
- First visit
- Pain HPI
- SOAP canvas
- Telemedicine intro
- Well-care F 21-40
- Well-care F 40-75
- Well-care M 40-75
- Vaccines adult check
- Medication lab cheatsheet
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ACEP patient handouts
Nate Friedman, MD
EM Resource.org
Administrative
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First visit

‍‍PAST HX:
‍‍﻿‍Medical Hx:﻿ ‍﻿ ‍none﻿ 
‍‍﻿‍Hospitalizations:﻿ ‍﻿ ‍none﻿ 
‍‍﻿‍Surgical Hx:﻿ ‍﻿ ‍none﻿ 
‍‍﻿‍Traumatic Hx:﻿ ‍﻿ ‍none﻿ 
‍‍﻿‍Medications:﻿ ‍﻿ ‍none﻿ ‍see list﻿ 
‍‍﻿‍Allergies:﻿ ‍﻿ ‍nkda﻿ 
‍‍﻿‍Vaccines:﻿ ‍﻿ ‍up-to-date﻿ 
‍‍﻿
‍‍SOCIAL HX:
‍‍﻿‍Tobacco:﻿ ‍﻿ ‍none﻿ 
‍‍﻿‍Alcohol:﻿ ‍﻿ ‍none﻿ 
‍‍﻿‍CAGE: _ / 4﻿ ‍feels should cut down,﻿ ‍has been annoyed by others,﻿  ‍feels guilty,﻿ ‍eye opener.﻿ 
‍‍﻿‍Drug misuse:﻿ ‍﻿ ‍none﻿ 
‍‍﻿‍Diet:﻿ ‍﻿ ‍﻿ 
‍‍﻿‍Exercise:﻿ ‍﻿ 
‍‍﻿‍Occupation:﻿ ‍﻿ 
‍‍﻿‍Ethnicity:﻿ ‍﻿ ‍﻿ 
‍‍﻿‍Home environment:﻿ ‍﻿ 
‍‍﻿
‍‍LAST SCREENING TESTS:
‍‍﻿‍Cholesterol:﻿ ‍﻿ ‍normal﻿ ‍﻿ 
‍‍﻿‍Diabetes:﻿ ‍﻿ ‍normal﻿ ‍﻿ 
‍‍﻿‍Fit test:﻿ ‍﻿ ‍negative﻿ ‍﻿ 
‍‍﻿‍Coloscopy:﻿ ‍﻿ ‍normal﻿ ‍﻿ 
‍‍﻿‍PSA:﻿ ‍﻿ ‍normal﻿ ‍﻿ 
‍‍﻿‍Mammogram:﻿ ‍﻿ ‍normal﻿ ‍﻿ 
‍‍﻿‍Pap smear:﻿ ‍﻿ ‍normal﻿ ‍﻿ 
‍‍﻿‍STDs:﻿ ‍﻿ ‍negative﻿ ‍﻿ 
‍‍﻿
‍‍FAMILY HX:
‍‍﻿‍HTN:﻿ ‍﻿ 
‍‍﻿‍Heart disease:﻿ ‍﻿ 
‍‍﻿‍Stroke:﻿ ‍﻿ 
‍‍﻿‍Obesity:﻿ ‍﻿ 
‍‍﻿‍Kidney disease:﻿ ‍﻿ 
‍‍﻿‍Substance abuse:﻿ ‍﻿ 
‍‍﻿‍Psychiatric:﻿ ‍﻿ 
‍‍﻿‍Colorectal cancer:﻿ ‍﻿ 
‍‍﻿‍Breast cancer:﻿ ‍﻿ 
‍‍﻿‍Prostate cancer﻿ ‍﻿ 
‍‍﻿‍Other:﻿ ‍﻿ 

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