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
Continue management at home
Requires a home visit
Requires a Hospital visit/Admission
Phone
Submit