ALK template
A professional Internal Medicine template for healthcare professionals.
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Chief Complaint
ALK template
Template
Thank you for the referral of [name] This [age] [gender] was seen today for assessment of allergies. The patient has history of «allergic rhinitis»«asthma diagnosis or asthma like symptoms»«food allergy»« or eczema.» Past Medical History Medications Allergies Social History Smoking: «y»«n» Type of home: «house»«apt»«condo» Pets: «y»«n»«cat»«dog» Air conditioning: «central» Carpeting: «y»«no»«bedroom»«stairs»«basement» Employment: Grade: Family history Physical Exam «insert» Allergy Skin Testing «Skin testing to common environmental allergens was <<positive/negative>> (includes: dust mites, cockroach, animals, tree, grass, ragweed, weeds, moulds).» « Skin tests for inhalants today were positive for XX» Impression and Plan Social History «insert»
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This comprehensive new patient template helps establish care by capturing complete medical history, current concerns, and baseline health status. Use this for patients during their initial visit to create a thorough medical record.
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