Chesrow Clinic

1) Female Intake form:

Typically I give this to the patient to fill out in the waiting room/have the MA give it to them when they are doing vitals. I review while they are getting undressed for the exam. Then I go in and review it with the patient and do the exam.

It's organised by diagnosis. See the annotated copy. You will have most of your A/P done before entering the room. It makes complicated patients a consistent workflow.

Once I am there, I will build the epic template to match so it's easy to enter.

2) Male Intake form:

For male voiding dysfunction patients

3) Bowel program:

-I circle on the form if I want them on fiber, miralax, or the recipe. The key is to start "slow and low" with whatever modality you use. Magnesium supplements can help in neurogenic patients.

4) Voiding diary form:

-1 day unless they need SNS or PTNS, then 3 day. Form works if they are on CIC as well.

5) Estrogen form:

-I always start with generic Estradiol (estrace) as it's cheap with goodrx.I typically print out the goodrx coupons and attach them to the instructions.

Almost every one I see gets a voiding diary, estrogen or a bowel program