Difference between revisions of "1.3.6.1.4.1.19376.1.5.3.1.1.16.1.4"
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|'''Header''' | |'''Header''' | ||
| − | ||R || || | + | ||R || || || |
|- | |- | ||
|'''Reason for Visit/Chief Complaint''' <br/> | |'''Reason for Visit/Chief Complaint''' <br/> | ||
| − | ||R || || | + | ||R || || || |
|- | |- | ||
|'''History of Present Illness'''<br/> | |'''History of Present Illness'''<br/> | ||
| − | ||R || || | + | ||R || || || |
|- | |- | ||
|'''Past Medical History'''<br/> | |'''Past Medical History'''<br/> | ||
| − | ||R || || | + | ||R || || || |
|- | |- | ||
|'''Social History'''<br/> | |'''Social History'''<br/> | ||
| − | ||R || || | + | ||R || || || |
|- | |- | ||
|'''Family History'''<br/> | |'''Family History'''<br/> | ||
| − | ||R || || | + | ||R || || || |
|- | |- | ||
|'''Review of Systems'''<br/> | |'''Review of Systems'''<br/> | ||
| − | ||R || || | + | ||R || || || |
|- | |- | ||
|'''Physical Examination'''<br/> | |'''Physical Examination'''<br/> | ||
| − | ||R || || | + | ||R || || || |
|- | |- | ||
|} | |} | ||
Revision as of 12:52, 24 April 2008
This is a draft of a History and Physical Template. This draft is a work in progress, not the official supplement or profile.
The intention of this work is to provide a parent template for the History and Physical specifications needed in Antepartum Summary Forms A&B (History and Physical).
Document Specification
| Data Element | Opt | Section | Template ID | Comments |
|---|---|---|---|---|
| Header | R | |||
| Reason for Visit/Chief Complaint |
R | |||
| History of Present Illness |
R | |||
| Past Medical History |
R | |||
| Social History |
R | |||
| Family History |
R | |||
| Review of Systems |
R | |||
| Physical Examination |
R |