SUMMARY ( FOR OFFICE USE ONLY)
General:
The patient, a {age} year old {gender} presents to the clinic complaining of {whereDo}. Symptoms began on {whenDid}. The pain is described as {howWould} and is {howOften}. The patient explains that symptims are{progressOf} since onset.
Patients Description of injury: {pleaseBriefly}
Activities of daily living that are affected include: {activitiesOf}
Prior Treatments: {whatTypes}
Auto Injury (If Applicable):
The patient, a {age} year old {gender} presents to the clinic complaining of {whereDo} as a result of an {whatBrings}. Symptoms began on {whenDid}. The pain is described as {howWould} and is {howOften}. The patient explains that symptims are{progressOf} since onset.
The patient, a restrained {positionIn} of a {typeOf78} was {mechanismOf} by a {otherVehicle}. The patients vehicle was driving at approximately {howFast} while the opposing vehicle was traveling at approximately {howFast85}. The patient explains that the road conditions during the time of the accident was {whatWere} and occurred during {whatWere76}.
At the time of the accident, the patient exhibited feelings of {whatWere87}.
Activities of daily living that are affected include: {activitiesOf}
Prior Treatments: {whatTypes}
After the accident the patient went {whereDid} via {howWere}.
The patient description of the accident: "{brieflyDescribe}"
Transported to Hospital/ER: {wereYou95}
If so, which Hospital: {whichHospital}
Imaging taken: {anyImaging}. Findings: {whatWere93}
Did you lose consciousness? {didYou}
Did you hit your head?{didYou132} If so, Where: {whereDid130}
Did you have any cuts/bruises? {didYou133}; If so where: {whereDo134} Stitches: {didYou135}
Did you miss any days from school or work: {missAny}; if so How many? {howMany}