brevaADHD follow-up
Encounter
Patient name: [ ] Date of birth: [ ] Date and time of encounter: [ ] Clinician: [ ]
Interval history
Patient and parent or caregiver present: [ ] Function at school, work and home as reported: [ ] Rating scales used, who completed them and scores: [ ]
Medication
Medication and dose as reported, timing and adherence: [ ] Benefit and duration of effect as reported: [ ] Appetite, sleep, mood and other adverse effects as reported: [ ] Prescription monitoring program checked and findings, if applicable: [ ]
Findings
Weight, blood pressure and heart rate measured today, with units: [ ] Other examination findings: [ ]
Assessment and plan
Current status and reasoning: [ ] Medication decisions and rationale: [ ] Behavioral or school supports discussed: [ ] Prescription and monitoring plan: [ ]
Follow-up
Follow-up timing and purpose: [ ] Return precautions discussed: [ ] Patient questions and understanding: [ ]