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Plastic & Reconstructive Surgeon Template

Consultation Note

A professional Plastic & Reconstructive Surgeon template for healthcare professionals.
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About this template

Need a clear and concise consultation note? This template is designed for plastic and reconstructive surgeons to document patient consultations efficiently. It provides a structured format to capture essential information, including the referring doctor, patient details, history of presenting illness, past medical and surgical history, medications, social history, physical exam findings, and the impression and plan. This template ensures all critical aspects of the consultation are addressed. With Heidi, this template can be quickly populated from your patient visit transcript, saving you valuable time on documentation. Start creating comprehensive and accurate consultation notes today.

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Dear Dr. Emily Carter, Thank you for your kind referral of Mrs. Evelyn Hayes. As you know, they are a very pleasant 62-year-old female who presents today with concerns regarding facial aging and a desire for facial rejuvenation. History of Presenting Illness Mrs. Hayes reports progressive changes in her facial appearance over the past several years, including deepening of nasolabial folds, sagging of the jowls, and the development of fine lines and wrinkles. She denies any acute onset of symptoms or associated pain. She is seeking consultation for potential cosmetic procedures to address these concerns. Past Medical History * Hypertension, well-controlled with medication. * Hypercholesterolemia, managed with diet and exercise. Past Surgical History * Appendectomy at age 10. Medications * Lisinopril 10mg daily. * Atorvastatin 20mg daily. Social History * Non-smoker. * Occasional alcohol consumption. * Lives with her husband. Physical Exam * Facial skin demonstrates moderate photoaging with fine lines and wrinkles. * Mild to moderate ptosis of the malar fat pads. * Deepening of nasolabial folds. * Mild jowling. * No significant asymmetry. Impression and Plan * Diagnosis: Facial aging. * Plan: Discussed various treatment options, including facelift, neck lift, and non-surgical interventions such as fillers and Botox. Patient is interested in a facelift and neck lift. Scheduled for pre-operative assessment and further discussion of surgical plan. Informed consent obtained.
Dear Dr. [referring doctor], Thank you for your kind referral of [patient's name]. As you know, they are a very pleasant [patient's age and gender] who presents today with [presenting complaint]. History of Presenting Illness [Insert presenting illness or complaint] Past Medical History [Insert past medical history] Past Surgical History [Insert Past surgical history] Medications [Insert current medication] Social History [Insert social history] Physical Exam [Insert physical exam findings for each system reviewed] Impression and Plan [Insert impression and plan] (For each section, only include if explicitly mentioned in transcript or context, else omit section entirely. Never come up with your own patient details, assessment, plan, interventions, evaluation, or next steps—use only the transcript, contextual notes, or clinical note as reference for all information. If any information related to a placeholder has not been explicitly mentioned, do not state that in the output; simply leave the relevant placeholder or section out entirely. Use as many lines, paragraphs, or bullet points as needed to capture all relevant information from the transcript.)
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Specialty

Plastic & Reconstructive Surgeon

Used

30 times

Type

Document

Last edited

14/4/2026

Created by

Rowan Chandler

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