www.marshallortho.com

GOOD SHEPHERD MC / MARSHALL  - MARSHALL, TEXAS

ORTHOPAEDIC HISTORY AND PHYSICAL

PATIENT NAME:   AGE/RACE/SEX:  

PRIMARY DR:  WEIGHT:

CHIEF COMPLAINT:

PAST MEDICAL HISTORY:

CURRENT MEDICATIONS:

ANTICOAGULANTS:  DIABETIC?: GOUT?: HYPERTENSION?:

MI?:  STROKE?: SEIZURES?:  GYN?

ALLERGIES:

---PHYSICAL FINDINGS : [VITAL SIGNS AS PER NURSE'S NOTES ON ADMIT]---

GENERAL:  

HEENT:  

CHEST/CARDIAC:

ABDOMEN:

EXTREMITIES:

INDICATIONS FOR SURGERY: 

                 [ALSO :  FAILURE OF CONSERVATIVE OR NON-OPERATIVE TREATMENT]

DIAGNOSIS: 

PLAN:

     ________      ___________________

                       D. Duncan, MD                              date / time

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-----DISCHARGE SUMMARY-----

 

PATIENT NAME:

FINDINGS:

TREATMENT:  

CONDITION ON DISCHARGE : GOOD

DISCHARGE MEDS:  __ LORTAB    __ DARVOCET  __ KEFLEX   __ BACTRIM    

   DISCHARGED TO HOME [nursing home if applicable]  AND  TO  PREVIOUS DIET

ACTIVITY :

OFFICE APPOINTMENT IN 1 WEEK     

FINAL DIAGNOSIS:

            ________          ___________________

                       D. Duncan, MD                                      date / time