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Autotext Dot Phrases for Cerner EHR

All templates, "autotexts", procedure notes, and other documents on these pages are intended as examples only for educational purposes.  Your documentation in the medical record should always reflect precisely your specific interaction with an individual patient.  Do not merely copy and paste a prewritten note element into a patient's chart - "cloning" is unethical, unsafe, and potentially fradulent.

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Disability Template

Date first seen for this problem: _

Date completing form: _

Treatment Intervals: [_] Daily [_] Weekly [_] Monthly [_] as needed.

Date first incapable of work: _

Anticipated Release date to return to work: _

Was the disability caused by a Trauma: [_] Y [_] N (if Yes,date of trauma or accident: _ )

Is the patient pregnant: [_] Y [_] N

Estimated Date of Delivery: _

Date Pregnancy ended: _

Vaginal or Cesarean: _

If the patient has not delivered and you do not anticipate releasing the patient to return to regular work prior to the estimated delivery date, enter the NUMBER of DAYS that the patient will be disabled for each delivery type: Vaginal _ Cesarean _

In case of an abnormal pregnancy and or delivery state the complications causing the disability: _

ICD 10 code

– Primary Diagnosis: _

-Secondary Diagnosis: _

-Secondary Diagnosis: _

- Secondary Diagnosis: _

Diagnosis, if no diagnosis has been made, enter a detailed statement of symptoms: _

Findings – State nature, severity, and extend of the incapacitating disease or injury, include any other disabling conditions: _

Type of Treatment/Medication rendered to the patient:_

If hospitalized, date of entry _ and date of discharge _.

If deceased date of death: _

City: _ County: _

Was the patient seen previously by another physician/practitioner or medical facility for the current disability/illness/injury? _

Date and type of surgery performed: _

Was the patient unable to work prior to the surgery or procedure?_

Procedure ICD-10 code (s): _

CPT Codes: _

Was the condition caused or aggravated by the patient regular/customary work? [_] Y or [_] N

Are you completing this form for the sole purpose of referring to an alcohol recovery or drug-free residential facility? [_] Y or [_] N

Date your patient became a resident of a drug or alcohol facility: _

Would disclosure of this information be medically or psychologically detrimental to the patient? [_] Y or [_] N

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