Acute Care General Surgery Service CONSULTATION

DATE:

TIME OF CONSULT:

ID: Age, Sex

REASON FOR REFERRAL:

HISTORY OF PRESENT ILLNESS:

The patient is @AGE@ @SEX@ who presents with ***

Last PO intake was ***.

ROS:

{ros master:310782}

PAST MEDICAL HISTORY:

PAST SURGICAL HISTORY:

ENDOSCOPIC HISTORY:

SOCIAL HISTORY:

Smoking:

Alcohol:

Recreational Drugs:

Occupation:

Functional Status (ADLs/IADLs):