Consultation note

[+] yes, present, positive
[-] no, absent, negative
[~] equivocal
[\] not applicable, not performed
[?] unknown, unsure, unavailable
{ } annotation, comment

PRESENTING COMPLAINTS OR ISSUES
Reasons for visit:
[-] new problem/issue
[-] review/follow-up

Presenting symptoms:
[+] 
[-]

History of presenting complaint:
-

Management to date:
-

Relevant diagnostic investigation results:
[+] 
[~] 
[-] 
[?]

History since last contact:
-

Patient's or carer's ideas, concerns and expectations:
-

PAST MEDICAL HISTORY
Relevant past medical history:
[+] 
[-]

ALLERGIES AND ADVERSE REACTIONS
Medication allergies or reactions:
-

PHYSICAL EXAMINATION
Relevant examination findings:
[+] 
[~] 
[-]

ASSESSMENT
Clinical summary:
[+] 
[~] 
[-]

Diagnosis/es:
1. 
2.

Differential diagnosis:
-

MANAGEMENT PLAN
Procedures performed:
-

Diagnostic investigations requested:
-

Referrals:
-

Patient information and advice:
-

Medication:
-

FOLLOW-UP
Outstanding issues:
-

Next appointment:
-

Consultation note

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