Patient presents with a history of motor vehicle accident (MVA).  Date of accident: [Date of Accident].  Location of accident: [Location of Accident].  Patient was the [Driver, Passenger, Pedestrian, Other - Specify].  Patient reports [Wearing, Not Wearing] a seatbelt at the time of the collision.  Point of impact was [Specify Point of Impact, e.g., driver's side, rear, frontal].  Emergency medical services [EMS] were [Called, Not Called].  Patient was transported to [Hospital Name] via [EMS, Private Vehicle, Other].  Initial injuries reported at the scene included [List Initial Injuries].  Current complaints include [List Current Complaints, e.g., neck pain, back pain, headache, whiplash].  Symptoms onset [Immediately, Delayed].  Pain characteristics described as [Describe Pain, e.g., sharp, dull, aching, radiating, throbbing].  Pain level [Numeric Pain Scale 0-10].  Associated symptoms include [List Associated Symptoms, e.g., numbness, tingling, dizziness, nausea, vomiting].  Past medical history significant for [List Relevant PMH].  Surgical history includes [List Relevant Surgical History].  Medications include [List Current Medications].  Allergies include [List Allergies].  Physical examination reveals [Detailed Physical Exam Findings Related to MVA].  Neurological examination [Normal, Abnormal - Specify].  Range of motion [Limited, Full - Specify affected area and degree of limitation].  Palpation reveals [Tenderness, Swelling, Crepitus - Specify Location].  Diagnostic studies ordered include [X-ray, CT scan, MRI - Specify body part].  Assessment:  History of motor vehicle accident with [Diagnosis Based on Examination and Diagnostics, e.g., cervical strain, lumbar sprain, concussion, whiplash injury].  ICD-10 code: [Appropriate ICD-10 Code].  Plan:  [Treatment Plan including medications, physical therapy, referrals, follow-up care, patient education on injury management and recovery].  Return to work status: [Specify Work Status and Restrictions].