Date of Visit :	{$adult_assessment.assessment_date}	Age:	{$age}
Present History :	{$adult_assessment.present_history}
Complaints and History of Present Illness :	{$adult_assessment.present_illness}
Past History:
Co-morbidities:	{$adult_assessment.comorbidities}
History of Previous Hospital Admission:	{$adult_assessment.prev_hos_admisssion}
Previous Surgeries:	{$adult_assessment.prev_surgeries}
Allergies:	{$adult_assessment.allergies}
Vaccinations :	{$adult_assessment.vaccinations}
Family History:	{$adult_assessment.family_history}
Cardiac Examination:	{$adult_assessment.cardiac_ex}
Chest Examination:	{$adult_assessment.chest_ex}

{if $adult_assessment.assessment_note} {/if}

ECG:	{$adult_assessment.ecg}	CXR:	{$adult_assessment.cxr}
Notes:	{$adult_assessment.assessment_note}

{if $medCount > 0}

Current Medication

{foreach $allMedData as $data } {/foreach}

Drug	Dosage frequency	Route	Duration	Action
				S	C	M
{$data.drugName}	{$data.drugdos}	{$data.route}	{$data.duration}	{$data.action_s}	{$data.action_c}	{$data.action_m}

{/if}

Provisional Diagnosis:	{$adult_assessment.prov_diagnos}
Plan:	{$adult_assessment.plan}

Patient was educated about his/her diagnosis, Plan of Care and follow up

Referral

{$ref_dr}

Physician name

{$phys.name}

Physician Signature:

{if $carePlanCount > 0}

Physician care plan – خطة رعاية الطبيب

{foreach $allCarePlanData as $data } {/foreach}

Date	Needs	Intervention	Outcome	Timeframe	Dr Signature
{$data.care_plan_date}	{$data.needs}	{$data.intervention}	{$data.outcome}	{$data.timeframe}

{/if}