Doctors Call Report

Phone Consultation Log

Use this form to document details of phone calls made to patients in lieu of visits due to self isolation rules for COVID-19 pandemic.

Name Of Doctor *

Name Of Patient *

Email Of Patient *

City *

Phone Call: Date / Time *

Date

Time

Question *

History Of Presenting Complaint *

Review Of Systems *

Assessments *

Prescription (If new medication required)

Summary *

Plan

Name