Medical Evaluation
Patient's Information:
Date: [DATE]
Introduction: This evaluation form is used by healthcare professionals for assessing an individual's physical health, diagnosing medical conditions, monitoring progress, or determining eligibility for certain treatments or services.
Overview: The information derived from this evaluation enables our healthcare professionals to provide better care and treatment options. This technique ensures efficient and precise collection and interpretation of patient data.
Evaluation Criteria
Please carefully assess and document the following criteria:
Criteria | Assessment |
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1. Medical History Review of past medical conditions, medications, surgeries, allergies, and family medical history.
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2. Physical Examination A thorough examination of the body systems, including inspection, palpation, percussion, and auscultation.
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3. Vital Signs Measurement of blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation.
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4. Diagnostic Tests | |
5. Assessment of Symptoms Evaluation of current symptoms reported by the patient, including their severity, duration, and impact on daily life.
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6. Review of Systems | |
7. Functional Status | |
8. Laboratory Results | |
9. Imaging Studies Interpretation of X-rays, CT scans, MRI scans, ultrasound, or other imaging modalities to visualize internal structures.
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10. Nutritional Assessment Evaluation of dietary habits, nutritional status, weight history, and risk factors for malnutrition or nutritional deficiencies.
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11. Medication Review Review of current medications, including prescription drugs, over-the-counter medications, and supplements.
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12. Immunization Status | |
13. Psychological Evaluation Screening for mental health conditions, cognitive function, mood disorders, and psychosocial stressors.
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14. Social History Exploration of social support networks, living arrangements, employment status, education, and lifestyle factors.
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15. Family Medical History | |
Additional Comments and Notes
Evaluation Templates @ Template.net
