CISP Club (French speaking ICPC fan club) www.cispclub.org download two forms in one page
Clinical data
management training course ICPC
Paper and Pencil coding form August
2000 – Updated 2007
|
ID doctor |
Consult Home- Hospit Tel |
Contact
date (dd/mm/yy) |
SOAP |
|
|
|
|
|
|
|||
|
ID
patient |
Known (Y/N) |
Sex (F/M) |
ZIP
Code |
BD (dd/mm/yy) |
|
|
|
|
|
|
|
|
|
O/N |
N°
probl |
RFE |
RFE |
RFE |
Proc |
Proc |
Proc |
Apr.. |
C/U |
Proc |
Proc |
Proc |
|
|
Probl
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Probl
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Probl
3 |
|
|
|
|
|
|
|
|
|
|
|
SOAP :
text if needed
(S reason for encounter, Objective not codable , Apraisal or diagnose, Plan)
O/N : old or new problem
RFE : as given by the patient or suggested by the doctor
Proc : before and after Apraisal
Apr : appraisal or work
hypothesis or diagnose
C/U : certain or uncertain
©Marc
Jamoulle et Michel Roland, MF&SP,
Août 2000