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Last Modified 1/05/2009


COPD Follow Up MedicalTemplate

The chronic obstructive lung disease (COPD) follow up MedicalTemplate is suitable for any health care provider that manages patients with COPD.   

This one page template contains detailed checklists for the severity of COPD symptoms, current and planned COPD therapy, and other features helpful for a comprehensive COPD treatment plan.

How to use MedicalTemplates


    Read this document on Scribd: COPD Follow Up

    COPD Patient Evaluation Date Time ROS Constitutional Eyes ENT/mouth Resp CV GI GU Musc Skin/breasts Neuro Endo Heme/lymph Allergy/Immun Psych WNL See HPI Patient Name Chief Complaint or Reason For Visit HPI DOB MRN Symptom Severity and Frequency ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰Asymptomatic with usual activity ‰Symptomatic with usual activity ‰Symptomatic with minimal activity ‰Symptomatic at rest ‰Recent antibiotic use ‰Recent oral steroid use ‰Recent ED visits ‰Recent hospital admissions ‰Weight loss/Decreased appetite Physical Exam ‰Checked box indicates findings are within normal limits General ENT Neck Resp CV GI Lymph Musc Extrem Skin Neuro FEV1 ‰At risk ‰Mild ‰Moderate ‰Severe ‰Very Severe >80% >79% 50-79% 30-49% <30% FEV1 FVC t 70% <70% < 70% < 70% < 70% ‰ Alert Vital signs Temp Pulse BP RR Pulse ox at rest With exercise History Allergies PMSH Social Family No changes See HPI ‰ Nasal mucosa ‰ Dentition ‰ Oropharynx Mallampati ‰I ‰II ‰III ‰IV ‰ Palpation ‰ Thyroid ‰ No JVD ‰ Auscultation ‰ Percussion ‰Respiratory effort ‰Palpation ‰Chest wall ‰ Clear S1 S2 ‰ No murmur ‰ No gallop ‰No rub ‰ Peripheral pulses ‰ No peripheral edema ‰No palpable masses ‰ No hepatosplenomegaly ‰ No hepatojugular reflux Tobacco Use ‰ Lymph nodes ‰Tone ‰ Gait ‰ Digits ‰ No rashes, ecchymoses, nodules, ulcers ‰ Orientation ‰Affect ______ # Packs X ______ # Yrs ‰Never smoked ‰Quit ‰Unwilling to quit ‰Willing to consider quitting ‰Quit, but resumed smoking ‰Willing to quit within 1 month COPD Therapy Current New Short-acting beta ‰ ‰ agonist Inhaled steroid Long-acting beta agonist Long acting anticholinergic Theophylline Oral steroids Antibiotics Nicotine replacement Buproprion Nicotine receptor blocker CPAP ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ ‰ Impression and Plan Tests to be ordered ‰Bronchoscopy ‰Pulmonary Function Testing ‰Methacholine challenge ‰6 Minute Walk Test ‰Sleep study ‰CXR ‰Chest CT ‰without contrast ‰Echocardiogram with ‰Bubble study ‰PA pressures ‰Cardiopulmonary Stress Test ‰Pulmonary Rehabilitation ‰Surgical eval for lung reduction ‰Bone density evaluation ‰Pneumococcal vaccine ‰Influenza vaccine ‰Labs BiPap Oxygen Therapy Education and Instruction ‰Smoking cessation ‰Peak flow meter use ‰Inhaler use ‰Importance of vaccinations ‰Risks of alcohol, narcotics and BZD Signature ‰Medication side effects CODE STATUS: ‰ Full code ‰ Do Not Attempt Resuscitation ‰Supplemental oxygen for air travel Data Reviewed ‰ ER Notes ‰ Old Chart ‰EMS Note ‰ECG ‰Nursing Notes & Vitals log ‰ Labs ‰ X Rays ‰MRI ‰US ‰CT Care Coordinated With ‰ER MD ‰HCPOA ‰Primary Care MD ‰Case Management ‰Social Worker ‰Pharmacy Follow up ©MB and RR 2006, 2007 www.e-medtools.com

    MedicalTemplate updated 2/25/2008

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Impact of COPD on the Healthcare system

The National Center for Health Statistics reports COPD to be the 4th leading cause of death in the Unites States, causing 124,000 deaths per year.  Over 24 million Americans have COPD, and women are more likely than men to die from COPD.   The major risk factor for developing and dying from COPD is tobacco smoking.  COPD is responsible for over 1 million hospital admissions and $37 billion dollars in healthcare costs each year.  Due to the large numbers of Americans with COPD and the heath care costs associated with the treatment of COPD, this chronic lung disease is a focus of many quality improvement initiatives and pay for performance programs.

  

E & M Documentation Template

The COPD follow up evaluation MedicalTemplate contains prompters and space for all the required elements for a E&M encounter.  

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Digital Health Record

The COPD follow up evaluation MedicalTemplate functions like all other PDF files, but they have editable text fields and working checkboxes.  This allows information to be typed in or pasted from other applications to fill out the template.

Filled MedicalTemplates can be printed and saved to a computer, USB drive, CD, DVD, or other storage device to create a digital health record for your patients.

To learn more about how MedicalTemplates can be used as a digital health record, click here.

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Digital Signature Enabled

MedicalTemplates can be signed with a digital signature, instead of a handwritten signature, if the use of a digital signature is acceptable at your practice location.   Adobe PDF digital signatures require the creation of a digital ID that is used to sign the PDF.  

To learn more about Adobe PDF digital signatures, click here.

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Pay for Performance

The COPD patient encounter template was designed to include Clinical Performance Measures for COPD developed by the Physician Consortium for Performance Improvement.


The Clinical Performance Measures for COPD can be downloaded from
here.


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MedicalTemplates are in the Adobe PDF format, which requires the free Adobe Reader.  With Adobe Reader, these templates can be printed as many times as needed on paper meeting your specifications or the specifications of any clinic, hospital, or other health care facility.