Patient Demographics
Name:
Age:
Sex:
Date of Birth:
Referring Physician:
Date of Consultation:
Consultant:
Specialty:
Reason for Visit
Briefly state the reason for this follow-up visit.
This could be to discuss the consultant’s recommendations, address any concerns arising after the consultation, or monitor progress related to the consultation findings.
Summary of Consultation
Briefly summarize the key points from the consultation, including:
Reason for referral
Consultant’s assessment and diagnosis (if applicable)
Recommended treatment plan
History Since Consultation
Inquire about the patient’s experience and any developments since the consultation.
Gather details on:
Adherence to the consultant’s recommendations (medications, investigations, lifestyle modifications)
Presence of any new or worsening symptoms
Questions or concerns arising from the consultation
Physical Examination (if applicable)
Perform a focused physical examination relevant to the consultation findings, if necessary.
Document any pertinent findings.
Assessment and Plan
Based on the patient’s reported experience and your examination findings (if applicable), assess their current health status in relation to the consultation.
Formulate a plan for ongoing care, considering:
Integration of the consultant’s recommendations into the patient’s overall treatment plan
Adjustments to medications or other treatment modalities as needed
Need for further investigations or referrals (based on consultant’s recommendations or your assessment)
Scheduling of follow-up appointments (with you or the consultant)
Patient Education
Address any questions or concerns the patient may have about the consultation findings, treatment plan, or their condition.
Provide additional education or resources as needed, such as:
Explanation of the consultant’s recommendations in simpler terms
Information about medications or treatment modalities
Lifestyle modifications to support recovery or manage the condition
Communication with Consultant
Briefly document any communication or collaboration with the consultant regarding the patient’s care.
This may include sending a summary of this visit or discussing any adjustments to the treatment plan.
Prognosis
Provide a brief update on the patient’s overall prognosis, considering their progress, the consultation findings, and the implemented treatment plan.
Note: This is a general template, and additional details may be necessary depending on the specific patient situation and the reason for the consultation.