Adult physical exam pdf
[DOC File]Tennessee
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Pertussis Vaccine Date (Adult Inoculation) Specify any physical, mental or emotional problems which would affect this person’s ability to care for a child. If the person is identified as other adult living in the home, indicate conditions detrimental to a child’s placement in the home.
[DOC File]Optional Long Term Care Assessment and Care Planning Tool
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This form was created by a group of Adult Family Home providers, resident advocates, Washington State DSHS/Aging and Adult Services Administration staff and professional assessors, and was designed to include the elements of an assessment required in WAC 388-76-61020. This is …
[DOCX File]ANNUAL PHYSICAL EXAMINATION FORM
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Dec 06, 2017 · GYN exam w/ PAP: Date: Results: (women over age 18) Mammogram: Date: Results: (every 2 years- women ages 40-19, yearly for women 50 and over) Prostate Exam: Date: Results: (digital method-males 40 and over) ... ANNUAL PHYSICAL EXAMINATION FORM Last modified by: …
[DOC File]American College of Physicians | Internal Medicine | ACP
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ADULT PROGRESS NOTE Date of Birth: _____ Date: _____ Medical Record Number: _____ ( New ( Return ( Periodic ( Chart Not Available ( Interval ED Visit ( Interval Admission
[DOCX File]Department of Emergency Medicine | University of Washington
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Physical Exam. Level 1 – one system. Level 2-3 – 2 systems. Level 4 – 5 systems. Level 5 – 8 systems. High Acuity caveat documentation-- it is acceptable to use these phrases when appropriate if you are unable to complete portions of the HPI or PE: unable to obtain history due to … unable to perform full exam due to … (crashed to OR ...
[DOCX File]Physical Exam Form - Department of Health Home
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Adapted in part from the Pre-participation Physical Evaluation History Form; ©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine.
[DOC File]source document template - Veterans Affairs
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these templates are for Pis and their study coordinators and should be used as examples or templates to build from and modify to meet their specific needs. Source document templates include inclusion/exclusion worksheet, adverse event tracking log, medications log, missed visit, early withdrawal form, study visit form, randomization form, study procedures form, physical evaluation form ...
[DOC File]Well-woman exam
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Title: Well-woman exam Author: Stacey Herrmann Last modified by: Bwhite Created Date: 4/7/2014 7:08:00 PM Company: AAFP Other titles: Well-woman exam
[DOC File]Completing the Biopsychosocial Assessment
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Indicate the client’s current health status by their own report and below enter the date of the last physical exam and comments/concerns from that exam. Significant Medical History: List any surgeries, head injuries, any type of accidents or trips to the emergency room, broken legs, stitches etc.
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