Folliculitis
A professional Dermatology template for healthcare professionals.
Preview template
OVERALL_INSTRUCTIONS
Chief Complaint
Folliculitis
Template
Date: [Insert Date] HISTORY OF PRESENTING ILLNESS: [Insert history of presenting illness] PAST MEDICAL HISTORY: Problem History: [Insert problem history or 'None Recorded'] MEDICAL HISTORY OF SKIN/HAIR ISSUES: [Yes | No] FAMILY HISTORY OF SKIN/HAIR ISSUES: [Yes | No] MEDICATIONS: External Medications: [Insert external medications or 'None Recorded'] ALLERGIES: Known Allergies: [Insert allergies or 'None Recorded'] OCCUPATION: [Insert occupation] PHYSICAL EXAM: [Full|Partial] skin exam completed. Fitzpatrick type [1|2|3|4|5|6]. DERMOSCOPY: [Insert dermoscopy findings] ASSESSMENT: Folliculitis PLAN: 1. Topicals: [BPO wash][Salicylic Acid Wash][2% clindamycin in betaderm lotion BID x 2 weeks then EOD]. 2. Oral: [Doxycycline 100 mg OD x 12 weeks][Apprilon 40 mg OD x 12 weeks][Isotretinoin 30 mg 2 - 3 times per week]. FOLLOW-UP: [2 weeks|4 weeks|6 weeks|8 weeks|3 months|6 months|1 year|PRN|When pathology results available] Thank you for involving me in the care of this patient. Yours sincerely,
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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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