Sample door sign

 for history and physical examination

First name Last name is a xx-year-old girl who presents to the clinic
for the evaluation of specific problem.

Vital signs:

Temperature:           xx.x ^oF

Respirations:           xx per minute

Pulse :                             xx bpm

Blood pressure:        xxx/xx mmHg

 Sample door sign for history and counseling

First name Last name is a XX-year-old woman who presents
 to the clinic for purpose of visit

Vital signs:

Temperature:           xx^oF

Respirations:           xx per minute

Pulse :                             xx bpm

Blood pressure:        xxx/xx mmHg

Sample door sign for history and counseling when laboratory studies are
included in the initial information

First name Last name is a xx-year-old man who presents to the clinic
because reason for coming in today.

The patient came to the clinic yesterday for lab studies to be done in
preparation for today’s visit.  The patient has not yet been informed
of the results of the lab tests.

VITAL SIGNS:                   Temperature   xx.x⁰ F

                                         Respirations   xx per min

                                         Pulse                      xx bpm

                                         Blood Pressure       xxx/xx mmHg

LABS (from yesterday): 

        Lab test #1:             results

        Lab test # 2:            results

        x-ray/other study      results

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This site was last updated on 01/20/2011.