Hematology Consult Note

Patient MRN:

Date: 

Staff Physician: 

Consult by: 

IDENTIFICATION:

HEMATOLOGIC HISTORY:

PAST MEDICAL HISTORY:

MEDICATION:

ALLERGIES:

FAMILY HISTORY:

SOCIAL HISTORY:

HISTORY OF PRESENTING ILLNESS:

PHYSICAL EXAM:

Vitals:

INVESTIGATIONS:

Labs:

Imaging:

IMPRESSION AND PLAN:

Sheharyar Raza R4 Hematology