A Telehealth Clinical Assessment Form is a document that is used when the healthcare professional is doing an online assessment of the patient's medical condition. This form is important because the plan of care will be based on the data entered on this clinical assessment form.
This Telehealth Clinical Assessment Form contains form fields that ask for patient information like name, contact details, marital status, gender, and occupation. It also has a medical data section where you'll see fields that ask for the primary complaint, vital signs, height, weight, allergies, current medications, existing medical conditions, previous hospitalization, and family history. It also has a table for each body system review which includes sensory, musculoskeletal, integumentary, neurovascular, circulatory, respiratory, dental, psychosocial, nutrition, and elimination. This form template is also using the Signature tool to capture the digital signature of the healthcare provider who did the assessment. Using the Form Builder, you can customize the form changing the color theme, font format, and layout. Jotform offers HIPAA compliance features which helps protecting sensitive healthcare data.