Doctor Progress Note Format

Patient Information

Name:                                                                       

Date of Birth:            /            /           

Date of Visit:            /            /           

Subjective (Patient’s Report)

Chief Complaint:                                                                                                                                                                                                                                                                                                                                                               

Symptoms Duration:                                                                                                                                     

Current Medications:                                                                                                                                    

Additional Notes:                                                                                                                                            

Objective (Clinical Observations)

Mental Status Exam:                                                                                                                                      

Appearance:                                                                                                                                                     

Behavior:                                                                                                                                                            

Vital Signs (if applicable)

Blood Pressure:                / mmHg

Heart Rate:                bpm

Other Observations:                                                                                                                                                                                                                                                                                                                                                               

Assessment (Diagnosis & Evaluation)

Primary Diagnosis:                                                                                                                                         

Progress Since Last Visit:                                                                                                                           

Current Concerns:                                                                                                                                         

Plan (Treatment & Recommendations)

Medication Adjustment:                                                                                                                              

Therapy/Counseling: Yes / No

Lifestyle Recommendations:                                                                                                                                                                                                                                                                                                                                                               

Follow-up Appointment:            /            /           

Provider’s Information

Doctor’s Name:                                                   

Credentials:                                                   

Facility Name:                                                   

Contact Information: