Patient Record Form

 

 

Question 1-10:

Complete the form below

Write NO MORE THAN THREE WORDS AND/OR A NUMBER for each answer

Temporary Patient Record Form

Name: Example

Peter Smith

Street address: 1. ………………………………
Suburb: 2. ………………………………
Phone number: 3. ………………………………

Details of injury

Sport: Tennis
Type of injury: Sprained 4. ………………………………
Date of injury: 5. ………………………………

Previous treatment and current problems

The patient’s own doctor advised treatment with 6. ……………………………….
The patient is unable to 7. ……………………………… and he is experiencing pain in his 8. ……………………………… at night, which is affecting his sleep.

Advice given

Stop using the 9. ………………………………
Do regular 10. ……………………………… at home

 

 


Keys

Here are the answers for Section 1:

      1. 95 Cross Street
      2. Walkley
      3. 4689 5324
      4. knee
      5. 18th June
      6. (an) ice pack
      7. go upstairs
      8. back
      9. stick
      10. exercises

 

 

Transcript

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