brevaSkin examination
Encounter
Patient name: [ ] Date of birth: [ ] Date and time of encounter: [ ] Clinician: [ ]
History
Patient concerns and changing lesions: [ ] Personal and family skin cancer history as reported: [ ] Relevant exposures and prior treatments: [ ] Medications and allergies reviewed: [ ]
Examination
Extent of examination and areas deferred or declined: [ ] Chaperone discussion and presence if applicable: [ ] Findings by anatomic site and laterality: [ ] Lesion dimensions, morphology and dermoscopic findings if assessed: [ ] Photographs obtained and consent if applicable: [ ]
Assessment and plan
Problem or lesion, clinical impression and differential: [ ] Management options and decisions: [ ] Procedures actually performed or planned: [ ] Counseling provided: [ ]
Follow-up
Follow-up timing and purpose: [ ] Return precautions discussed: [ ] Patient questions and understanding: [ ]