2. FOLl_OW—UP PATIENT EVALUATION Awoovea EAR, NOSE & THROAT CENTER 198 MASSACHUSETFS
Avswus NORTH Amoovsn, MA 01845 978.685.7550
CC/HCC: (Location, Quality, Severity, Duration, Timing, Modifying Factors, Associated Signs & Symptoms) (1 -3elements -)
Level 2, 4-8 -) Level 3,4,5)
PHYSICAL EXAMINATION (no mark = not examined) _
WNL ABNORMAL N‘) B GENERAL: Communication Muod & Affect Orientation EYES: EOMI PERLLA Nystarnus
Conjuctiva
EARS
External Appearance EAC - Right
EAC — TM — Right TM — NOSE External Septum Turbinates
Muoosa
Lips/Gums/Teeth Oral MucosafF OM
Phalynx Tongue/Palate/Uvula Tonsil
Throat
Vocal Cords
Assess ment/Impression: (ML, VC Mobility
Other