Title Page

  • Patient name

  • Conducted on

  • Prepared by

  • Location


S - Subjective

  • Ask your patient for their chief complaints and describe them here. Follow the OLD CHARTS or OLD CARTS acronym for a more in-depth subjective talk with your patient.

  • Enter patient's chief complaint here

O - Objective

  • Enter patient's vital signs here

A - Assessment

  • Enter your preliminary assessment here

  • The next section can be repeated as many times as necessary depending on the status and needs of the patient

  • P - Plan
  • Enter your plan here

Additional Progress Notes

  • Enter any additional progress notes here

Sign off

  • Prepared by

  • Date

  • Possible follow-up consultation date

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.