Cannabis prescription
Age: years old
Gender:
HISTORY:
Presents requesting medical cannabis for
Previous treatments tried:
,
,
,
,
,
,
Contributing factors:
no history of: , , , , , , ,
no use of: , , ,
Smoking: , pack-years
Alcohol: , drinks per
Recreational drugs: ,
EXAM:
General appearance: ,
Vital signs: , BP , HR , RR , SpO2 %, Temp °
Mesures
Neck: , , , c-spine
Heart: , ,
Lungs: , ,
Abdomen: , , ,
Extremities: , , cap refill sec, pulses , ,
Musculoskeletal: joints ,
Cervical spine: on , range of motion
Shoulder: : on , range of motion
Elbow: : on , range of motion
Wrist: : on , range of motion
Hand: : on , range of motion
Lumbar spine: on , range of motion
Hip: : on , range of motion
Knee: : on , range of motion
Ankle: : on , range of motion
Foot: : on , range of motion
Neurologic: cranial nerves , strength , sensation , reflexes , cerebellar function , gait
Mental status: , , speech , mood , thought , , judgment
ASSESSMENT:
PLAN:
Investigations:
- Blood work: , , , , , , , ,
- Urine toxicology screen
Treatments:
-
- Psychoeducation about medical cannabis
- Regular monitoring of symptoms and side effects
Further care:
- Referral to pain management specialist
- Referral to psychiatrist
- Referral to psychologist
- Referral to addiction services
- Follow-up in
- Return if symptoms worsen, if new symptoms develop such as anxiety, depression, or suicidal thoughts
HISTORY: EXAM: ASSESSMENT: PLAN: