Patient: [Patient Name] MRN: [Medical Record Number] Date: [Date of Visit]
Chief Complaint: Briefly describe the patient’s main reason for this visit. This could include:
Change in shortness of breath or activity tolerance
Increased oxygen needs
Headache, confusion, or other new symptoms
Problems with the oxygen equipment
Refill request
History of Present Illness:
Duration of home oxygen use
Any recent changes in underlying medical condition (e.g., respiratory infection, heart failure exacerbation)
Changes in oxygen saturation (SpO2) on pulse oximetry
Changes in activity level or functional status
Frequency and duration of oxygen use
Oxygen Settings:
Liter flow rate (L/min)
Delivery method (nasal cannula, mask)
Duration of use (continuous, intermittent)
Physical Examination:
Vital signs (respiratory rate, oxygen saturation)
Assessment of respiratory effort (work of breathing)
Auscultation of breath sounds (presence of wheezing, crackles)
Peripheral edema (swelling in legs or feet)
Pulse Oximetry:
Oxygen saturation (SpO2) on room air and with supplemental oxygen
Assessment:
Adequacy of oxygen therapy (meeting oxygen saturation goals)
Effectiveness of oxygen delivery system
Patient education and adherence to oxygen therapy
Plan:
Adjust oxygen settings as needed (if SpO2 outside target range)
Refill oxygen tank or concentrator (if applicable)
Order additional supplies (tubing, filters)
Schedule for next visit
Consideration for arterial blood gas (ABG) testing (if clinically indicated)
Referral for respiratory therapy evaluation (if needed)
Address any equipment concerns
Education:
Importance of using oxygen as prescribed
Warning signs of low oxygen levels
Proper cleaning and maintenance of oxygen equipment
Healthy lifestyle modifications (smoking cessation, weight management)