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Patient Disease Profile

Introduction to the patient

 Name:

 T #:

 Age:

 Weight:

 Gender:

 Bed #:

 Ward: Daycare

 Address:

 Hospital name:

 DOA:

 MO :

Chief complaints (c/c or P/c)

HOPI

PMH
Social or personal history

Family history

Physical examination

 Vitals:

 B.P: / mmHg

 Pulse: beats/min

 R/R: breaths/min

 Temperature:

 Jaundice:

 System Hx

PLAN:

Lab Tests:
Therapy:

Diagnosis

Treatment

Drug Interactions

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