1.3.6.1.4.1.19376.1.5.3.1.1.16.1.4
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 |