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Renewal
Age: years old
Gender:
HISTORY:
Presents for a medication renewal
Last visit was ago
Medications:
Adherence:
Tolerance:
Current symptoms:
Smoking: , pack-years
Alcohol: , drinks per
Recreational drugs: ,
Caffeine: daily
Diet: , , , ,
Physical activity:
Weight: ,
Labs:
EXAM:
General appearance: ,
Vital signs: , BP , HR , RR , SpO2 %, Temp °
Neck: , , , c-spine
Heart: , ,
Lungs: , ,
Abdomen: , , ,
ASSESSMENT:
PLAN:
Investigations:
- Blood work: , , , , , , , ,
Treatments:
- Medications renewed for months
Further care:
- Follow-up in
- Return if side effects occur or condition worsen
HISTORY: EXAM: ASSESSMENT: PLAN:
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