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   Orthopaedic History and Physical     Good Shepherd MC / Marshall    Marshall, Texas

DO NOT REMOVE FROM CHART !!!!

Patient name :           Primary Care Dr :   

  

 Chief complaint :          HPI as below:

   

  Allergy :        other:  

  Diabetic :        Hypertensive:     Gout :      Steroid use :

Anticoagulant :                  HAND :     

Current meds :       

REVIEW OF SYSTEMS :

 HEENT :   

CHEST / CARDIAC :   

GI/GU :   

MUSC-SKEL :   

SMOKER :            EtOH : 

LAST TETANUS SHOT : 

EXAM:

 GENERAL :  WD WN    DISTRESS

HEENT:    

CHEST / CARDIAC : 

 ABDOMEN : 

EXT / SPINE :   

X-RAY :  

 IMPRESSION :  

PLAN :   

DATE/TIME :              

                                                                           D. Waldman, MD

Dictation job # :     revised 4/9/08