brevaChronic condition follow-up
Encounter
Patient name: [ ] Date of birth: [ ] Date and time of encounter: [ ] Clinician: [ ]
Interval history
Conditions addressed today: [ ] Changes since the previous visit: [ ] Patient priorities and functional impact: [ ] Medication use, response, adverse effects and access barriers: [ ]
Findings
Home readings with dates, source and units: [ ] Vitals measured today, with units: [ ] Relevant examination findings: [ ] Results reviewed with dates: [ ]
Problem-based assessment and plan
Condition and current status: [ ] Evidence supporting the assessment: [ ] Treatment decisions and rationale: [ ] Monitoring, orders and agreed goals: [ ]
Follow-up
Follow-up timing and purpose: [ ] Return precautions discussed: [ ] Patient questions and understanding: [ ]