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Obstetrics Gynecology Specialist
5-10 minutes

Consultation for New Prolapse/Incontinence Template

The Prolapse/Incontinence Consultation template by s10.ai is crafted specifically for Obstetricians and Gynecologists to efficiently document initial consultations for patients with urinary incontinence or prolapse. This all-encompassing template includes sections for patient demographics, history of present illness, bowel habits, fluid consumption, and more, ensuring a comprehensive evaluation. It facilitates the creation of detailed clinical notes encompassing physical examination results, assessments, and management strategies. This template is perfect for healthcare professionals aiming to optimize documentation processes and elevate patient care. Implement this template with s10.ai to boost efficiency and precision in clinical documentation.

1,218 uses
4.1/5.0
D
Dr. Mark Chen
Template Structure

Organized sections for comprehensive clinical documentation

Patient Details:
- [patient name] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [patient age] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [patient gender] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [patient contact information] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Visit Purpose:
- [describe current issues, reasons for visit, discussion topics, history of presenting complaints etc] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Current Illness History:
- [describe onset, duration, and progression of urinary incontinence and/or prolapse symptoms] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [mention any associated symptoms such as pain, discomfort, or urinary frequency] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- [describe any previous treatments or interventions for urinary incontinence and/or prolapse] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Bowel Habits:
- [bowel symptom]: [frequency of bowel movements]
- [description of bowel movements]
- [previous treatment for bowel symptom]
Hydration:
- [amount and type of fluid intake]
- [amount and type of fluid intake]
- [amount and type of fluid intake]
Medical Background:
- [describe past medical history, previous surgeries] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Current Medications:
- [mention medications and herbal supplements] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Known Allergies:
- [mention allergies] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Lifestyle and Social History:
- [describe social history, including lifestyle factors such as smoking, alcohol use, and physical activity] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Genetic and Family History:
- [mention any relevant family history of urinary incontinence, prolapse, or other related conditions] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
System Review:
- [describe any other relevant symptoms or issues in other body systems] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Clinical Examination:
- [describe findings from the physical examination, including pelvic exam and any relevant tests] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Clinical Assessment:
- [provide a summary of the clinical assessment, including diagnosis or differential diagnosis] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Management Plan:
- [outline the proposed management plan, including any recommended treatments, medications, lifestyle modifications, or referrals] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Next Steps:
- [mention any follow-up appointments or further investigations required] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
Once again, thank you for involving me in her care.
Sample Clinical Note

Example of completed documentation using this template

Patient Information:
- Jane Doe
- 58
- Female
- 555-123-4567
Reason for Visit:
- Jane is concerned about urinary incontinence and pelvic pressure.
History of Present Illness:
- Symptoms started around 6 months ago and have gradually worsened. Jane experiences urinary leakage during coughing or sneezing and feels pelvic heaviness.
- Additional symptoms include mild pelvic discomfort and increased frequency of urination.
- Jane has attempted pelvic floor exercises with little improvement.
Bowel Function:
- Constipation: 2-3 times weekly
- Hard stools, requires straining
- Occasionally uses over-the-counter laxatives
Fluid Intake:
- Consumes 2 liters of water daily
- 1 cup of coffee in the morning
- Occasionally drinks herbal tea in the evening
Past Medical History:
- Hypertension, controlled with medication
- Appendectomy at age 25
Medications:
- Lisinopril 10mg daily
- Multivitamin
Allergies:
- Penicillin
Social History:
- Non-smoker, consumes alcohol socially
- Engages in 30 minutes of walking daily
Family History:
- Mother experienced uterine prolapse
Review of Systems:
- No other significant symptoms reported
Physical Examination:
- Pelvic exam shows mild anterior vaginal wall prolapse
- No significant tenderness observed
Assessment:
- Stress urinary incontinence with mild cystocele
Plan:
- Recommend pelvic floor physical therapy
- Consider fitting a pessary
- Discussed lifestyle changes including weight management
Follow-Up:
- Follow-up in 6 weeks to evaluate progress and consider additional interventions
Once again, thank you for involving me in her care.
Clinical Benefits

Key advantages of using this template in clinical practice

  • This comprehensive clinical template is designed to streamline the documentation process for healthcare professionals managing patients with urinary incontinence and prolapse. By incorporating high-search healthcare and clinical keywords, this template ensures that all critical patient information, including history of present illness, bowel function, fluid intake, past medical history, medications, allergies, social and family history, review of systems, physical examination, assessment, plan, and follow-up, is meticulously captured. Clinicians can efficiently document patient encounters, enhancing the quality of care and facilitating better patient outcomes. Explore and implement this template to optimize your clinical workflow and improve patient management.
Frequently Asked Questions

Common questions about this template and its usage

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Consultation for New Prolapse/Incontinence | Medical Chart Template