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Edit Clinical Notes AOHC - Male Preventative Care
i Narrative View n j k l m n j Template View k l m
Vital Signs:
g Premature c d e f graph sheet
HT:
graph sheet
WT:
Add BP CM KG
percentile:
Mother's Stature
percentile:
Father's Stature
HT/WT:
percentile:
BMI:
percentile:
Add PEFR CM CM
Status:
BSA: graph sheet
Systolic
graph sheet
CM
WC:
BP:
Diastolic
Limb
graph sheet
HR:
BPM:
Rhythm:
graph sheet
RR:
BPM:
Desc:
graph sheet
T:
graph sheet
SpO2:
graph sheet
PEFR:
graph BS: sheet Lifestyle/Habits
째C
Cuff Size Adult
/
Date 5
2
2013
^ DD/MM/YYYY
Desc:
Location:
i pre-bronchodilator n j k l m n j post-bronchodilator k l m
L/min
5
2
2013
^
DD/MM/YYYY
mmol/L
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Diet:
Fat/Cholesterol:
Fiber:
5
5
5
6
6
6
Calcium:
Sodium:
Family:
5
5
5
6
6
6
Exercise:
Relationships:
Smoking:
5
5
5
6
6
6
Alcohol:
Drugs:
5
Sexual
5 History:
5
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5 6 Sleep:
6
5
5
6
6
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Functional Inquiry
HEENT normal: HEENT:
CVS normal: CVS:
c d e f g
Sexual Function normal: Sexual Function:
c d e f g
5
5
6
6
c d e f g
MSK normal: g c d e f MSK:
5
5
6
6
Resp normal: g c d e f Resp:
GI normal: GI:
6
Family Planning/Contraception:
Neuro/Falls normal: g c d e f Neuro/Falls:
5
5
6
6 Derm normal: g c d e f Derm:
c d e f g 5
5
6
6
GU normal: g c d e f GU:
Cognition normal: g c d e f Cognition:
5
5
6
6 Mental Health normal: g c d e f
Constitutional SX normal: g c d e f Constitutional SX:
5
Mental Health:
Depression Screen: Yes No
5
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5 6
6
Other:
5
6
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Education/Counselling (male):
adverse nutritional habits discussed: g c d e f dietary advice on fat/cholesterol (30-69): g c d e f adequate calcium intake (1000-1500 mg/d) discussed
c d e f g
adequate vitamin D (400-1000 IU) intake discussed: g c d e f regular, moderate physical activity discussed: g c d e f avoid sun exposure discussed: g c d e f tanning salon use discussed: g c d e f seat belts discussed: g c d e f hearing protection discussed: g c d e f noise control programs discussed:
c d e f g
safe sex practices/STDs/BC discussed: g c d e f physical violence in environment discussed: g c d e f safe firearm storage (if applicable) discussed: g c d e f home hazards discussed: g c d e f smoke detectors in the home discussed:
c d e f g
regular testing of smoke detectors discussed: g c d e f
For general population unless otherwise stated Obesity (BMI>=30): Yes No
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weight loss counselling if overweight: g c d e f screen for mental illness: g c d e f multidisciplinary approach:
Alcohol: Yes No
Elderly: Yes No
Smoking: Yes No
c d e f g
counselling for problem drinking: g c d e f case finding for problem drinking:
c d e f g
cognitive assessment (if concerns): g c d e f fall assessment (if history of falls): f g c d e
smoking cessation discussed: g c d e f smoking cessation program referral: g c d e f dietary c d e f g advice
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advice nicotine replacementgiven: therapy discussed: g c d e f
c d e f g Oral Hygiene: g c d e f
brushing/flossing teeth discussed: g c d e f tooth scaling and prophylaxis discussed: g c d e f fluoride (toothpaste/supplement) discussed: f g c d e
Parents with Children: Yes No
g c d e f helmet safety: g c d e f
hot water thermostat (<54째C):
non-flammable sleepwear: g c d e f poison control prevention:
c d e f g
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Physical Examination (male) Physical Examination Conducted: Yes No
Eyes normal: Eyes:
c d e f g Visual Acuity / Snellen Sight Card Done:
5
c d e f g
Left 20/
Left With Glasses/Visual Aids:
c d e f g
Right 20/
Right With Glasses/Visual Aids:
c d e f g
6
Ears normal: Ears:
Nose normal:
c d e f g
Hearing Discussed: g c d e f Right ear:
Left ear:
5
5
5
6
6
6
c d e f g
Abdomen normal: f g c d e Abdomen:
Nose:
5
5
6
6
Mouth/Throat normal: g c d e f Mouth/Throat:
Ano-Rectum normal: g c d e f Ano-Rectum:
5
5
6
6
Neck/Thyroid normal: f g c d e Neck/Thyroid:
Genitalia normal: g c d e f Genitalia:
5
5
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5
5
6
6
CVS normal: f g c d e CVS:
Neuro normal: f g c d e Neuro:
5
5
6
6
Resp normal: g c d e f Resp:
Derm normal: Derm:
c d e f g
5
5
6
6
MSK/Joints normal: g c d e f
Extremities normal: g c d e f
MSK/Joints:
Extremities:
Male Body Diagram:
5
5
6
6
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