New Patient Meet & Greet Note

OVERALL_INSTRUCTIONS

Chief Complaint

[reason_for_visit]

Template

Patient Information: Name: [patient_name] DOB: [date_of_birth] Gender: [gender] OHIP #: [ohip_number] Reason for Visit: Patient goals / concerns: [patient_goals_concerns] History of Present Illness (HPI): Brief summary of current concerns (if any): [current_concerns_summary] Duration: [duration] Relevant symptoms: [relevant_symptoms] Past Medical History (PMH): (Check or list as applicable) Cardiovascular: (e.g., HTN, CAD, AFib, HF) [cardiovascular_conditions] Neurological: (e.g., Stroke, TIA, Parkinson’s, Epilepsy) [neurological_conditions] Respiratory: (e.g., COPD, Asthma) [respiratory_conditions] GI: (e.g., GERD, Crohn’s, UC, Celiac, Cirrhosis) [gi_conditions] Endocrine: (e.g., Diabetes) [endocrine_conditions] MSK: (e.g., Arthritis, Chronic pain) [msk_conditions] Psychiatric: (e.g., Depression, Anxiety, Bipolar, etc.) [psychiatric_conditions] Substance use history: (Drugs / Alcohol) [substance_use_history] Other: [other_pmh] Past Surgical History (PSH): [past_surgical_history] Medications (Med): Medication + dose + frequency [medications] Allergies (Allx): Drug allergies: [drug_allergies] Other allergies: [other_allergies] Family History (FHx): Condition – relation [family_conditions] Social History (SHx): Occupation: [occupation] Living situation: [living_situation] Smoking: Y/N [smoking_status] Alcohol: [alcohol_use] Recreational drugs: [recreational_drugs] Exercise / hobbies: [exercise_hobbies] Children / family: [children_family] Immunizations: [immunization_status] Details: [immunization_details] Assessment: Summary of key medical issues: 1. [medical_issue_1] 2. [medical_issue_2] 3. [medical_issue_3] Plan: Preventive care / screening: [preventive_care] Labs / investigations: [labs_investigations] Referrals: [referrals] Medication review / adjustments: [medication_review] Follow-up plan: [follow_up_plan] Additional Notes: Patient does not have a family physician: Y/N [no_family_physician] Counseled re: clinic prescribing policies (opiates, benzos, stimulants, etc.) [counseling_notes]