Family Practice Management Feature Article Manuscript s1
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Today’s Visit
Main reason for today’s visit: ______
Other concerns I would like to discuss if there is time: ______
Check all that apply: I have prescriptions that need to be refilled. I need a school or work excuse. I need a referral for my insurance company. I need the attached forms filled out. I would appreciate prayer today.
Patient’s name: ______
Date of birth: ___/___/___ Page 2
Developed by Cornerstone Family Health, Williamsport, Pa. Copyright © 2003 American Academy of Family Physicians. Physicians may photocopy or adapt for use in their own practices; all other rights reserved. “Focusing on Today’s Visit.” Redka JW. Family Practice Management. June 2003:59-60, www.aafp.org/fpm/ 20030600/59focu.html.
Copyright © 2018 by the American Academy of Family Physicians. All rights reserved.