Healthwise

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Follow-Up Appointment

Overview

Answer the following questions before and during your appointment to follow up on a health problem.

Concerns

What health problem is the reason for this return appointment?


What questions or concerns do I want addressed during this appointment?


Do I have any new symptoms? Yes ___ No ___ If yes, include how long I have had them and what helps relieve them. If I have pain, describe where it is, how it feels, and how severe it is.


Treatment issues

Have I had any difficulty carrying out my treatment for this condition? Yes ___ No ___ If yes, describe briefly:


Have I had any recent stresses that may affect my ability to care for the condition I have? Yes ___ No ___ If yes, describe briefly:

Do I need any special written information or instructions to help me care for the disease or condition I have, such as instructions about monitoring my blood sugar if I have diabetes? Yes ___ No ___


Are there any new treatments or tests for this condition?


What are the benefits and risks of the new treatments or tests?


What could happen if I choose not to have the new treatment or test?


Follow-up

What signs and symptoms should I watch for?

When should I call to report signs and symptoms?

When should I contact my health professional? Fill in the appropriate box below with the date and time, if needed.

Check here if no contact is needed.

____

Call to find out test results or to report how I am doing:

Date: _______ Time: _______

Return for an appointment:

Date: _______ Time: _______

Reminder

Bring all the records you have been keeping since your last visit, such as a blood sugar record if you have diabetes.

Credits

Current as of: October 6, 2021

Author: Healthwise Staff
Medical Review:
Catherine D. Serio PhD - Behavioral Health
Adam Husney MD - Family Medicine

Due to the threat of the COVID-19 (Coronavirus), we are taking precautionary measures to protect our staff and patients. We are implementing a temporary NO VISITOR policy at this time. Only patients or patients and their guardians will be allowed into the office. Please note, this is not to inconvenience anyone! The virus is a very real threat and it is essential that we stay healthy in order to provide needed care for our patients. If you are sick, we ask that you CALL the office to speak with a nurse before you come in. The nurse will provide specific instructions for you. Please DO NOT enter the office if you are sick (upper respiratory symptoms, fever, cough, or flu like symptoms). We are closely monitoring the situation and will update you as circumstances change. Thank you for your understanding!!