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Last Modified 1/05/2009

Hypertension Evaluation Medical Note Template

The hypertension evaluation MedicalTemplate is suitable for any health care provider that manages patients with known or suspected hypertension (high blood pressure). 

The hypertension evaluation MedicalTemplate includes all required E&M documentation elements for even the highest levels of complexity for established patients.

How to use MedicalTemplates


    Read this document on Scribd: Hypertension Follow up Evaluation

    Hypertension Evaluation Date Start Time Stop time Patient Name Patient DOB MRN Chief complaint/Reason for consult History of Present Illness Referring MD Data Reviewed ‰Allergy list ‰Medication list ‰Past Medical History ‰Past Surgical History ‰Social History ‰Family Medical History ‰Patient’s Blood Pressure log ‰Recent labs and diagnostic tests Review of Systems ‰Premature Coronary Artery Disease ‰Hyperlipidemia ‰Cardiac disease ‰Congenital Adrenal Hyperplasia ‰Diabetes ‰Dyslipidemia ‰Renal disease ‰Polycystic Ovarian Syndrome ‰Sleep Apnea ‰Renal artery stenosis Pulse Sitting RR Standing ‰Thyroid disease ‰BMI t  ‰Smoking ‰Physical inactivity Physical Exam Vitals Ht Wt BMI BP L arm R arm General ‰ Alert Eyes ENT Neck Resp CV GI Lymph Musc Extrem Skin Neuro Psych Supine ‰ = Patient denies problems ‰Constitutional ‰Eyes ‰Vision changes ‰Pain ‰Weight changes ‰Fatigue ‰Fever ‰ENT/mouth ‰Resp ‰CV ‰GI ‰Ulcers ‰Tooth pain ‰Nose bleeds ‰Dyspnea ‰Cough ‰Sputum ‰Chest pain ‰Exercise intolerance ‰Diaphoresis ‰Paroxysmal nocturnal dyspnea ‰Nausea ‰Vomiting ‰Diarrhea ‰ Abdominal pain after eating ‰Dysuria ‰Polyuria ‰Erectile dysfunction ‰Myalgias ‰Bony pain ‰Claudication ‰Sores, ulcers ‰Dry, cracked skin ‰Numbness ‰Paresthesias ‰Focal weakness ‰Hypoglycemia ‰Tremors ‰GU Additional Findings ‰Conjunctivae ‰Pupils ‰Discs ‰No visible retinal pathology ‰Nasal mucosa ‰Dentition ‰Oropharynx ‰Normal to palpation ‰Thyroid ‰No JVD ‰Clear to auscultation ‰Clear to percussion ‰Effort ‰Normal to palpation ‰Auscultation ‰Palpation ‰Edema ‰Carotids ‰Aorta ‰Femoral pulses ‰Pedal pulses ‰No palpable masses ‰Liver and spleen not palpable ‰No hepatojugular reflux ‰No lymphadenopathy ‰Enlarged lymph nodes palpable ‰Neck ‰Axilla ‰Groin ‰Other ‰Gait ‰Digit ‰Inspection ‰ROM ‰Stability ‰Strength ‰No clubbing ‰No cyanosis ‰No sores ‰Inspection ‰Palpation ‰Oriented ‰CN ‰DTR ‰Sensation intact ‰Vibratory sense intact ‰Affect ‰Orientation ‰Insight ‰Memory ‰Musc ‰Skin/breasts ‰Neuro ‰Endo Impression & Plan Blood Pressure Class ‰Normal ‰Prehypertension ‰Stage 1 ‰Stage 2 SBP <120 120-139 140-159 t160 DBP <80 80-89 90-99 t100 ‰Patient at goal < 140/90 or <130/80 for DM ‰Not at Goal ‰Heme/lymph ‰Allergy/Immun ‰Psych ‰Easy bruising ‰Swollen lymph nodes ‰Sinus pain ‰Nasal discharge ‰Depression ‰Anxiety ‰Hallucinations Follow up ‰This clinic ‰Endocrinology ‰Nephrology ‰Ophthalmology ‰Other Signature cc Estimated Creatinine Clearance * Multiply by 0.85 for females Normal Creatinine Clearance in healthy young females ~100mL/min/1.73m2 Normal Creatinine Clearance in healthy young males ~120mL/min/1.73 m2 (140 – age) x weight (in kg) = Plasma Creatinine x 72 Labs Therapy ‰Urinalysis ‰CBC ‰PT, PTT, INR ‰BMP ‰LFTs ‰Triglyceride level ‰LDL and HDL ‰BNP ‰EKG ‰ECHO ‰TSH ‰Aspirin ‰ACE-I or ARB ‰Beta blocker ‰Calcium Channel Blocker ‰Thiazide diuretic ‰Loop diuretic ‰Statin ‰Other ©MB and RR 2006-2008 Revised 10March08 e-medtools.com


    Template updated 3/10/2008

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E & M Documentation Template

The hypertension evaluation MedicalTemplate contains prompters and space for all the required elements for a E&M encounter.  

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Digital Health Record

The hypertension evaluation MedicalTemplate functions like all other PDF files, but they have editable text fields and working checkboxes.  This allows information to be typed in or pasted from other applications to fill out the template.

Filled hypertension evaluation MedicalTemplates can be printed and saved to a computer, USB drive, CD, DVD, or other storage device to create a digital health record for your patients.

To learn more about how MedicalTemplates can be used as a digital health record, click here.

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Digital Signature Enabled

Hypertension evaluation MedicalTemplates can be signed with a digital signature, instead of a handwritten signature, if the use of a digital signature is acceptable at your practice location.   Adobe PDF digital signatures require the creation of a digital ID that is used to sign the PDF.  

To learn more about Adobe PDF digital signatures, click here.

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JNC 7 Guidelines

The hypertension evaluation MedicalTemplate includes the hypertension staging system  and reminders for the suggested laboratory workup outlined in the JNC 7 report.  The JNC 7 is the The Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure of the National Heart, Lung, and Blood institute.  

JNC 7 Full Guidelines
JNC 7 Pocket Reference



The hypertension evaluation medical note template can be customized to meet your needs.   

To request a quote for a customized hypertension evaluation medical note template, send an email to

MedicalTemplates are in the Adobe PDF format, which requires the free Adobe Reader.  With Adobe Reader, these templates can be printed as many times as needed on paper meeting your specifications or the specifications of any clinic, hospital, or other health care facility.