Initial History and Physical Assessment Form

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QualityTool

Initial History and Physical Assessment Form

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Related Profile:

Comprehensive, Patient-Centered Program Incorporates Strategies That Help HIV Patients Maintain Their Health, Leading to Enhanced Adherence, Better Outcomes, and Fewer Deaths

Description

This comprehensive form can be used by health care providers to collect information at the initial interview session for all new patients in an HIV program.

The form includes the following sections:

Demographics
HIV exposure risks
History of present illness
Past medical history
Physical exam
Assessment
Discharge planning

Free registration is required.

Links to the Tool:
This tool is available at: http://www.ihi.org/knowledge/Pages/Tools/InitialHistoryandPhysicalForm.aspx

Developer

Christiana Care Health Services

Funding Sources

Christiana Care Health Services

QualityTool Topic

Disease/Condition-Related; Quality improvement strategies

History

Release Date: 03/2003
Original Summary: 12/2008

Disclaimer: The inclusion of a tool in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality or Westat of the tool or of the submitter or developer of the tool. Read more.

QualityTool Classification

Disease/Clinical Category:

AIDS

HIV

Stage of Care:

Primary care

Patient Care Process:

Assessment

Chronic-disease management

Primary care

QualityTool Format:

Questionnaire/Survey