List of Master Templates in Nightingale

Template Name ABDOMEN/GI (HPI) Ankle Injury AOHC - Adult Nutrition AOHC - Child and Youth Preventative Care AOHC - Chiropody AOHC - Counselling AOHC - Female Preventative Care AOHC - Male Preventative Care AOHC - Paediatric Nutrition AOHC - Physiotherapy AOHC - Quitting or Reducing Smoking ASTHMA ASSESSMENT Back Pain Basic Note BCCFP Congestive Heart Failure Initial Visit BCCP Congestive Heart Failure Care Record C.N.S (HPI) CDH PRE-OP Hx & Px CDM - Asthma Care CDM - COPD Care CDM - Diabetes Care CDM - Heart Failure Care CDM - Hypertension Care CHEST & RESPIRATORY (HPI) CHRONIC PAIN CLINICAL NOTE: CLINICAL NOTES - FREE TEXT CONSULTATION RECORD CPE-Female CPE-Male CPX (Female) CPX (Male) CV SYSTEMS (HPI) Depression DIABETES MANAGEMENT Dyspepsia EARS (HPI) ENDOCRINE (HPI) ENT-Adult Single text box for recording clinical notes Free Form Consultation Record Complete Physical Exam (Female) Complete Physical Exam (Male) Review of systems, history, and physical exam findings for female patients. Complete physical exam, male patient. Record Hx and physical findings related to the cardiovascular system Common findings on history and objective observation in a depressed patient. Diabetes Management Common history and physical exam findings in a patient with a chief complaint of dyspepsia. Record Hx and physical findings related to the ear Record Hx and physical findings related to the endocrine system Ear Nose & Throat Exam (Adult) Record Hx and physical findings related to the central nervous system Re-production of CDH pre-op form. Asthma Care COPD Care Diabetes Care Heart Failure Care Hypertension Care Record Hx and physical findings related to the respiratory system Subjective, objective text areas, and vitals. Template to collect the information that is not automatically linked from the patient's chart into the BCCFP CHF form. Adult Nutrition Child/Adolescent Preventative Care Chiropody Counselling Template Description Record Hx and physical findings related to the GI system All Fields Reportable

AOHC - Diabetes Education Diabetes Education Female Preventative Care Male Preventative Care Paediatric Nutrition Physiotherapy Quitting or Reducing Smoking USING THE STRING BUILDER

Reference Document for Nightingale on Demand March 2013

List of Master Templates in Nightingale

ENT-Child EYE (HPI) Free Style Entry G.U. SYSTEMS (HPI) Gastroesophageal Reflux Handwritten note Head Injury HEMATOLOGY (HPI) Hypertension Knee injury LAB RESULTS LIPID MANAGEMENT Low Back Pain Migraine Mini Mental Status-String Mini-Mental Status Exam MOUTH AND THROAT (HPI) MSK (HPI) NOSE (HPI) Nurse Hx/Vitals Otitis Media PEDIATRIC EXAM Pharyngitis PHYSICAL EXAM (Short) PLANTAR'S WART (Treatment) Prostatic Symptoms Adapted from Folstein et al, Mini Mental State, J PSYCH RES 12:196-198 (1975) Record Hx and physical findings related to the mouth and throat Record Hx and physical findings related to the Musculoskeletal system Record Hx and physical findings related to the nose Nurse's hx and vital signs Otitis Media history and physical findings. Pediatric Physical Exam A template for assessing a patient with a complaint of pharyngitis. Physical Examination using short PE dialogue Plantars warts treatment with liquid nitrogen Common history and physical findings in a patient complaining of prostatic symptoms. Record Hx and physical findings related to the dermatologic system Record Subject & Objective notes in free form Complete Review of Systems SOAP format using Hx Builder with nurse notes Record Subject & Objective with Nurse's Notes and Vital Signs Common subjective and objective findings in a patient suspected of having a urinary tract infection. Common history and physical items for a patient with a simple upper respiratory tract infection. Common history and physical elements for a patient complaining of vertigo. Record weight loss progress Record Weight loss program Record Weight loss program Record a well baby visit Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Ear Nose & Throat Exam (Child) Record Hx and physical findings related to the eye Different Free Style Entries Record Hx and physical findings related to the GU system Common history and physical findings in a patient suspected of having GERD. Basic note with subjective and objective spaces that will accept free form handwriting without converting to text; for use with a tablet computer. History and physical exam items for a patient presenting with a complaint of head injury. Record Hx and physical findings related to hematology History and physical exam for hypertension, based on CHEP 2003 Recommendations for the Management of Hypertension. Common history and physical findings in a patient with a knee injury. Manually recording common lab result values Management of lipid abnormalities

PSYCHIATRY (Symptoms) Record symptoms related to psychiatry SKIN/HAIR/NAIL (HPI) SOAP (Female) SOAP (Free form) SOAP (Male) SOAP Complete(ROS) SOAP Hx Builder SOAP w/ VITALS (Free form) Urinary Tract Infection URTI Vertigo WEIGHT LOSS WEIGHT LOSS (Female) WEIGHT LOSS (Male) WELL BABY Well Baby Check (12-13

Reference Document for Nightingale on Demand March 2013

List of Master Templates in Nightingale

months) Well Baby Check (15 months) Well Baby Check (18 months) Well Baby Check (2 months) Well Baby Check (4 months) Well Baby Check (6 months) Well Baby Check 1 Month (Optional) Well Baby Check 2 weeks (Optional) Maintenance, by Drs. L Rourke, J Rourke and D Leduc. Revised Aug. 2009. Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, J Rourke and D Leduc. Revised Aug. 2009. Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, J Rourke and D Leduc. Revised Aug. 2009. Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, J Rourke and D Leduc. Revised Aug. 2009. Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, J Rourke and D Leduc. Revised Aug. 2009. Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, J Rourke and D Leduc. Revised Aug. 2009. Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, J Rourke and D Leduc. Revised Aug. 2009. Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, J Rourke and D Leduc. Revised Aug. 2009.

Well Baby Check 9 months Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health (Optional) Maintenance, by Drs. L Rourke, J Rourke and D Leduc. Revised Aug. 2009. Well Baby Check Within 1 Week Well Baby Record - Guide I: 1 Week Well Baby Record - Guide Ib: 2 weeks (optional) Well Baby Record - Guide Ic: 1 month Well Baby Record - Guide IIa: 2 months Well Baby Record - Guide IIc: 6 months Well Baby Record - Guide IIIb: 12-13 months Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, J Rourke and D Leduc. Revised Aug. 2009. Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, and J Rourke; Revised July 2011 Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, and J Rourke; Revised July 2011 Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, and J Rourke; Revised July 2011 Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, and J Rourke; Revised July 2011 Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, and J Rourke; Revised July 2011 Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, and J Rourke; Revised July 2011

Well Baby Record - Guide Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health IVa: 18 months (national) Maintenance, by Drs. L Rourke, and J Rourke; Revised July 2011 Well Baby Record - Guide IVb: 2 years Well Baby Record - Guide IVc: 3 years Well Baby Record - Guide IVd: 4 years Well Baby Record - Guide IVe: 5 years Well Child Check (2 Years) Well Child Check (3 Years) Well Child Check (4 Years) Well Child Check (5 Years) Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, and J Rourke; Revised July 2011 Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, and J Rourke; Revised July 2011 Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, and J Rourke; Revised July 2011 Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, and J Rourke; Revised July 2011 Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, J Rourke and D Leduc. Revised Aug. 2009. Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, J Rourke and D Leduc. Revised Aug. 2009. Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, J Rourke and D Leduc. Revised Aug. 2009. Adapted from the Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance, by Drs. L Rourke, J Rourke and D Leduc. Revised Aug. 2009.

Baseline SF-36 Questionnaire Baseline SF-36 Questionnaire Baseline Womac Questionnaire HUI-3: Baseline Questionnaire Physical Activity Form Baseline Womac Questionnaire HUI-3: Baseline Questionnaire Physical Activity Form

Reference Document for Nightingale on Demand March 2013