Appendix A

Patient Note

If you write the patient note by hand, you will fill out a form similar to this after each patient encounter.

HISTORY: Include significant positives and negatives from history of present illness, past medical history, review of system(s), social history, and family history.

PHYSICAL EXAMINATION: Indicate only pertinent positive and negative findings related to the patient's chief complaint.

DIFFERENTIAL DIAGNOSES: In order of likelihood (with 1 being the most likely), list up to 5 potential or possible diagnoses for this patient's presentation (in many cases, fewer than 5 diagnoses are likely):

1.
2.
3.
4.
5.

DIAGNOSTIC WORKUP: List immediate plans (up to 5) for further diagnostic workup:

1.
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4.
5.