brevaNew patient visit
Encounter
Patient name: [ ] Date of birth: [ ] Date and time of encounter: [ ] Clinician: [ ]
Visit priorities
Patient concerns and goals: [ ] Current symptoms and relevant timeline: [ ]
History
Medical and surgical history: [ ] Family history: [ ] Social history and relevant exposures: [ ] Current medications, doses as reported and reconciliation: [ ] Allergies and reactions: [ ] Preventive care records reviewed and dates: [ ]
Examination
Vitals measured today, with units: [ ] Examination performed and findings: [ ]
Assessment and plan
Each problem addressed and supporting findings: [ ] Diagnostic or treatment decisions: [ ] Preventive services discussed: [ ] Records requested and responsibility for follow-up: [ ]
Follow-up
Follow-up timing and purpose: [ ] Return precautions discussed: [ ] Patient questions and understanding: [ ]