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Sports physician Template

Male Medicare Wellness Visit

A professional Sports physician template for healthcare professionals.
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Specialty

Sports physician

Used

83 times

Type

Note

Last edited

11/4/2025

Created by

Caleb Holder

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About this template

The Male Medicare Wellness Visit template is designed for sports physicians and other healthcare providers conducting annual wellness visits for male patients. This comprehensive template covers patient information, health risk assessments, medical history, preventive services, and patient education. It ensures a thorough evaluation of chronic conditions, functional ability, psychosocial and behavioral risks, and preventive care needs. The template also facilitates discussions on advance care planning, making it an essential tool for optimizing patient health and wellness. Ideal for capturing detailed clinical notes, this template supports efficient documentation in Heidi, enhancing patient care and compliance with Medicare requirements.

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Medicare Annual Wellness Visit (Male) Patient Information: John Doe Date of Birth: 01/15/1950 Visit Details: Date of Visit: 08/20/2024 Reason for Visit: Annual wellness check-up Health Risk Assessment: Chronic Condition #1: Hypertension - Well-controlled with Lisinopril 10mg daily. Recent blood pressure reading: 120/80 mmHg. Last appointment with cardiologist on 08/15/2024. Chronic Condition #2: Type 2 Diabetes - Managed with Metformin 500mg twice daily. Recent HbA1c: 6.5%. Last endocrinologist visit on 08/10/2024. Chronic Condition #3: Osteoarthritis - Managed with physical therapy and NSAIDs as needed. Recent X-ray shows mild progression. Current Health Status: Stable with no new complaints. Functional Ability and Level of Safety: Independent with no fall risk. Psychosocial Risks: Depression screening negative. Cognitive function intact. Behavioral Risks: Non-smoker, occasional alcohol use. Nutrition and Physical Activity Assessment: Balanced diet, exercises regularly. Medical History: Past Medical History: Appendectomy in 1980, benign prostatic hyperplasia. Family History: Father had prostate cancer, mother had cardiovascular disease. Current Medications and Supplements: Lisinopril, Metformin, Vitamin D supplement. Allergies: Penicillin Preventive Services: Screening Tests and Preventive Services Due: Prostate cancer screening (PSA scheduled), colorectal cancer screening up to date, cardiovascular risk assessment completed. Immunizations Status: Flu vaccine received, pneumococcal and shingles vaccines up to date, Tdap booster due. Assessment and Plan: Assessment of Current Health Status: Prostate health stable, no issues with sexual function. Plan for Addressing Health Risks and Preventive Services: Continue current medications, schedule PSA test, Tdap booster. Referrals to Other Healthcare Providers: None needed at this time. Follow-up Appointments: Next annual visit in 12 months. Patient Education and Counseling: Topics Discussed: Importance of regular exercise, balanced diet, and maintaining a healthy weight. Patient's Understanding and Agreement with the Plan: Patient agrees and understands the plan. Advance Care Planning: Discussion of Advance Directives: Discussed and patient has completed advance directives.

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