Individual Report
Name/MR#
:
DOB
:
Sex
:
Diagnoses
:
Influenza Vacc
:
Risk Factors
:
Pneumoccal Vacc
:
Initial
DC
I-DC % Chg
FU
I-FU % Chg
Goal
Meets or exceeds goal
Short of goal and moving in the wrong direction
Value meeting defined target or goal.
Report Used for:
Individual Patient Progress Report
Patient Progress Report For Physician
1
Higher or lower targets may be warranted based on patient's clinical history and risk status
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