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    Initial Assessment Form Specialist OPD

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    vicndub
    This medical assessment report documents a patient's complaint, medical history, allergies, physical examination findings, investigations, diagnosis, treatment, recommendations, and travel recommendations if applicable. Key details include the patient's level of consciousness, vital signs, other examination findings, assessment, prescribed treatment and management, and whether the patient is fit to fly and any special travel accommodations needed. The treating doctor signs off with their name and date.

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    Initial Assessment Form Specialist OPD

    Uploaded by

    vicndub
    3K views1 page
    This medical assessment report documents a patient's complaint, medical history, allergies, physical examination findings, investigations, diagnosis, treatment, recommendations, and travel recommendations if applicable. Key details include the patient's level of consciousness, vital signs, other examination findings, assessment, prescribed treatment and management, and whether the patient is fit to fly and any special travel accommodations needed. The treating doctor signs off with their name and date.

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    This medical assessment report documents a patient's complaint, medical history, allergies, physical examination findings, investigations, diagnosis, treatment, recommendations, and travel recommendations if applicable. Key details include the patient's level of consciousness, vital signs, other examination findings, assessment, prescribed treatment and management, and whether the patient is fit to fly and any special travel accommodations needed. The treating doctor signs off with their name and date.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    3K views1 page

    Initial Assessment Form Specialist OPD

    Uploaded by

    vicndub
    This medical assessment report documents a patient's complaint, medical history, allergies, physical examination findings, investigations, diagnosis, treatment, recommendations, and travel recommendations if applicable. Key details include the patient's level of consciousness, vital signs, other examination findings, assessment, prescribed treatment and management, and whether the patient is fit to fly and any special travel accommodations needed. The treating doctor signs off with their name and date.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    BIMC Hospital Kuta

    PATIENT STICKERS

    ………………………………… ASSESSMENT REPORT

    Patient Complain / Medical History

    Allergy :
    Past Medical History

    Physical Examination
    Level of Consciousness : ………. Respiration rate : ……….x/min Temperature : ……….0C
    Blood Pressure : …………mmHg Pulse : ……….x/min O2 Saturation : ……% on ……
    Other Examination Findings :

    Investigations

    Assessment / Diagnosis

    Treatment / Management

    Recommendation / Doctor’s Note

    Travel Recommendation (if applicable)


    Patient is fit to fly ? □ Yes □ No
    Patient need □ Ordinary seat □ wheelchair assistance □ stretcher case □ business class / extra leg space
    Patient can travel □ unescorted □ with non medical escort □ with medical escort
    Patient ask repatriation □ Yes □ No □ no choice In Doctors Opinion Is This Medically Necessary ? □ Yes □ No
    Treating Doctor’s Name : Signature :

    Date : Time :

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