Medical Telephone Consultation Form

The Medical Telephone Consultation Form can be used for recording the details of a patient call.

Extracted Text for Proper Search

TELEPHONE CONSULTATI	ON FORM	 	B 	J 	N 	S 	ES 	O 	DOCTOR ONLY	 	
NURSE	 	 
DATE	 	 	TIME	 	 	
 
 
CALL BACK	 	
URGENT	 	
 
 
RETURNING YOUR CALL	 	
PERSONAL	 	 PATIENT 
NAME	 	 	 	CALLER	  	 	
HOME	 	(         ) 	
WORK	 	(         ) 	 	
 	 	 	
ASSESSMENTS	 	TEMP	 	 	 	
 TEST RESULTS	 	DATE	 	 	 	
 PROGRESS	 	SEEN	 	 	 	
PRESENTING PROBLEMS	 	 	
 	 	
 	 	
 	PLAN	 	
 	 	
 	 	
 	 	
 	 	
 	ALLERGIES	 	
 	 	
 	 	 
 	INITIAL	 	PHARMACY	 	INITIAL	 	 
DATE	 	 	 PROBLEM