Geriatric H&P Template
======================

Chief Complaint / Reason for Visit:

History of Present Illness:
- Onset/Duration:
- Functional Impact:
- Caregiver Concerns:

Past Medical History:
- Chronic Conditions:
- Surgeries/Hospitalizations:
- Falls History (12 months):

Medications & Allergies:
- Prescription:
- OTC/Supplements:
- High-Risk Medications:

Functional Status:
- ADLs:
- IADLs:
- Mobility Aids:

Cognition & Mood:
- Baseline Cognition:
- Screening Results (MMSE/MoCA):
- Depression/Anxiety Screening:

Sensory:
- Vision:
- Hearing:

Social / Living Situation:
- Residence:
- Caregiver Support:
- Advanced Directives:

Review of Systems (Focused on Geriatric Syndromes):
- Nutrition/Weight Loss:
- Continence:
- Sleep:
- Pain:

Physical Exam Highlights:
- Vital Signs (orthostatics if indicated):
- General Appearance:
- Neuro/Cog:
- Cardiovascular:
- Musculoskeletal:

Diagnostics:
- Labs:
- Imaging:

Assessment:
- Problem List with Status:
- Geriatric Syndromes Identified:

Plan:
- Diagnostics/Referrals:
- Medication Adjustments:
- Therapy/Support Services:
- Follow-up:

Provider Signature & Credentials
Date / Time