COMPREHENSIVE NOTE

NAME ID DATE PHYSICIAN LOCATION GENDER: MF TEXTBOX
Y N NA ITEM OBJECTIVE/ASSESSMENT/PLAN
ADEQUACY: Kt/V URR


























ACCESS OK
AVF AVF maturing AVX sched AVG CVC
ANEMIA/HEME IN TARGET: HGBFE/IBC
FETIBCFERRITIN
PLTSWBCEPO R
HypercoagulableAnticoagulationPlatelet Antibodies
ALBUMIN/INFLAMMATION/NUTR: ALB BMI
Recent weight loss, muscle wasting/loss of appetite? YN
Self education - diet and fluids?YN
METABOLIC/HEPATIC/DM: GLUCOSEHGBA1C
Abnormal liver/thyroid fx studies? Serum Potassium
PSYCHOSOCIAL: Depression, non adherence or an abnormal KDQOL? YN
Rehabilitation needed?YN Adv Directives
CKD-MBD: PO4CAPTHVascCalcif
VitD low
INF CONTROL:
HepBAg POS HepBabFLU VACPNUVAX
FUTURE
Interested in transplant? YNPRA
KARNOFSKY MIS CCI SQ
CARDIAC/BP/VOL/VC
Gains > 3 kg btwn treatments? NY BP/
Counseled/reinforced on salt/fluids?YESNO
ACUTE-CO-MORBIDS: PneumoniaGI blee pericarditis
CHR-CO-MORBIDS: SickleCellMclonalGamMDA
NO CHANGE IN EXAM/MEDS/RX:
Stable Unstable

DOCTORSIGNED DATE

© 2008-12, Stephen Z. Fadem, M.D., FACP, FASN. All rights reserved. No part of this application may be duplicated without written permission from the author.

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