Select:
Dietition
NP
RN
RPN
Pharmacist
Psychologist
SMHW
Other
Select:
Email/Internet
Home Visit
Lab
Office Visit
OTN
Telephone
Other
Select:
On time
Arrived Late
Arrived Late - Rescheduled
No Show
Cancelled
N/A
Spoke to patient
Spoke to caregiver
Spoke to 3rd party
Left a message
N/A
Childcare
Forgot
None
Illness
School
Transportation
Work
Weather
Other
Initial
Follow-up
Not Applicable
1
2
3
4
5
Select:
Smoking cessation
Diabetes
Osteoporosis
Mental Health
Obesity
Smoking cessation
Nutritional counselling
Prenatal nutrition
Senior's wellness
Hypertension
Immunizations
Prenatal care
Cancer screening
Select:
Advise/Educate/Inform
Allergy Shot
Book Appointment
Case Review
Clinician Assist
Cognitive Testing
Ear Syringe
ECG
Flu Shot
FOBT Kit Provided
Forms, Letters, Notes...
Immunizations
Injections
Liquid Nitrogren
Loop Monitor
PAP
Periodic Health Visit/CPX
Prep/Clean up
Respiratory Therapy
Spirometry
Suture/Staple Removal
Swab/Rapid Strep Test
Triage
Urine Dip
Venupuncture
Vitals/Measurements
Wound Care
Other
Returning for follow-up
Discharge
Not applicable
Subject:
