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Text File  |  1994-01-24  |  3KB  |  43 lines

  1. 19
  2. 5,11,6,8,18,10,6,"Date",11,33,"","137C9T","Enter the date of the initial new patient exam in MMDDYY format (110293).","UDATE"
  3. 9,33,6,6,18,16,6,"Blood Pressure",0,33,"","137C9T","Enter the systolic and diastolic rates in 000/00 format.","UBP"
  4. 10,33,3,3,18,22,3,"Respiration",0,32,"","137C9T","Enter the rate of respiration, up to 2 digits (00).","URESP"
  5. 11,33,3,3,18,25,3,"Pulse",0,32,"","137C9T","Enter the pulse rate here, up to 3 digits.","UPULSE"
  6. 9,59,6,6,18,28,6,"Temperature",0,33,"","137C9T","Enter the patient's temperature reading in 000.00 format (98.6, 102.4).","UTEMP"
  7. 10,59,3,3,18,34,3,"ft.",20,32,"","137C9T","Enter the patient's height measured in feet (5 = 5 ft. tall).","UFT"
  8. 11,59,3,3,18,37,3,"in",20,32,"","137C9T","Enter the patient's remaining height measured in inches (6 = 6 inches)","UIN"
  9. 12,59,4,4,18,40,4,"lbs",0,32,"","137C9T","Enter the patient's weight in pounds (120, 45, etc.).","ULBS"
  10. 13,59,2,2,18,44,2,"oz",0,32,"","137C9T","If applicable, enter the patient's remaining weight in ounces (2, 10, etc.).","UOZ"
  11. 17,21,1,3,18,46,1,"Blood Sugar",13,33,"YN-Yes;No;","137C9T","","UBLDSUG"
  12. 18,21,1,3,18,47,1,"Urinalysis",13,32,"YN-Yes;No;","137C9T","","UURIN"
  13. 19,21,1,3,18,48,1,"Cholesterol Count",13,32,"YN-Yes;No;","137C9T","","UCHOL"
  14. 20,21,1,3,18,49,1,"CBC",13,32,"YN-Yes;No;","137C9T","","UCBC"
  15. 21,21,1,3,18,50,1,"Thyroid",13,32,"YN-Yes;No;","137C9T","","UTHY"
  16. 22,21,1,3,18,51,1,"EKG",13,32,"YN-Yes;No;","137C9T","","UEKG"
  17. 19,42,1,3,18,52,1,"Pap Smear",13,33,"YN-Yes;No;","137C9T","","UPAP"
  18. 20,42,1,3,18,53,1,"Mammogram",13,32,"YN-Yes;No;","137C9T","","UMAM"
  19. 19,66,1,3,18,54,1,"Prostate",13,33,"YN-Yes;No;","137C9T","","UPROS"
  20. 20,66,1,3,18,55,1,"Hernia",13,32,"YN-Yes;No;","137C9T","","UHERNIA"
  21. 21
  22. ┌────────┐┌────────┐┌────────┐┌────────┐┌─────────┐┌─────────┐┌───────┐╔═════╗
  23. │Personal││Policy 1││Policy 2││Policy 3││Condition││Diagnoses││Account│║Other║
  24. ┴────────┴┴────────┴┴────────┴┴────────┴┴─────────┴┴─────────┴┴───────┴╜     ╙
  25.    DATE:                 NEW PATIENT INITIAL EXAMINATION                      
  26.                                                                               
  27.                                    VITAL SIGNS                                
  28.                                                                               
  29.                Blood Pressure:              Temperature:                      
  30.                   Respiration:               Height--ft:                      
  31.                         Pulse:                       in:                      
  32.                                             Weight--lbs:                      
  33.                                                      oz:                      
  34.                                                                               
  35.                          LABORATORY TEST(S) TO BE ORDERED                     
  36.                                                                               
  37.       Blood Sugar:                 FEMALE                    MALE             
  38.        Urinalysis:                                                            
  39. Cholesterol Count:           Pap Smear:               Prostate:               
  40.               CBC:           Mammogram:                 Hernia:               
  41.           Thyroid:                                                            
  42.               EKG:                                                            
  43.