AKR MedCore — Electronic Medical Records

1 Patient Demographics

First Name

Middle Name

Last Name

Sex *

Birthdate *

Age

Member Type

Contact Number *

PhilHealth No. *

PhilHealth Patient Type *

Principal Member's PhilHealth No. *

Address

Patient Documents

Liveness Check

Screenshot or selfie photo

Choose File

Mutual Care Agreement

Signed agreement photo or PDF

Choose File

Documents are uploaded automatically when you save the patient record. Max 10 MB per file. JPG, PNG, PDF accepted.

2 Vital Signs

Height (cm) *

Weight (kg) *

Temperature (°C) *

Heart Rate (bpm) *

Blood Pressure *

Respiratory Rate *

Visual Acuity Right

Visual Acuity Left

Blood Type

3 Social History

Smoking Status *

Packs per Year

Alcohol Use *

Bottles per Year

Illicit Drug Use *

Yes No

Sexually Active *

Yes No

4 Past Medical History

Asthma Cerebrovascular Disease Coronary Artery Disease Diabetes Mellitus Emphysema Epilepsy Hyperlipidemia Hypertension Peptic Ulcer Pneumonia Thyroid Disease Urinary Tract Infection Mental Illness

Allergies

Highest BP (if hypertensive)

Cancer (specify)

Hepatitis (specify)

PTB (specify)

Other Conditions

Past Surgery

Surgery Date

5 Family History

Asthma Cerebrovascular Disease Coronary Artery Disease Diabetes Mellitus Emphysema Epilepsy Hyperlipidemia Hypertension Peptic Ulcer Pneumonia Thyroid Disease Urinary Tract Infection Mental Illness

Allergies

Highest BP (if hypertensive)

Cancer (specify)

Hepatitis (specify)

PTB (specify)

Other Conditions

6 Immunizations

BCG OPV 1 OPV 2 OPV 3 DPT 1 DPT 2 DPT 3 Measles Hep A (2) Hep A (3) Varicella HPV MMR Pneumococcal Flu Vaccine

Others

7 Menstrual History

Menarche Age

Age at First Sexual Intercourse

Last Menstrual Period

Period Duration (days)

Pads per Day

Cycle Interval (days)

Birth Control Method

Menopause

Yes No

8 Pregnancy History

Gravida (G)

Para (P)

Term (T)

Preterm (PT)

Abortion (A)

Living Children (L)

Delivery Type

Pregnancy-Induced Hypertension

Yes No

9 Physical Examination

HEENT

Essentially Normal Abnormal pupillary reaction Dry mucous membrane Icteric sclerae Pale conjunctivae Sunken eyeballs Sunken fontanelle

Others:

Chest / Lungs

Heart

Abdomen

Genitourinary

Rectal Exam

Skin & Extremities

Neurological

10 Pediatric Measurements Optional

Body Length (cm)

Head Circumference (cm)

Chest Circumference (cm)

Abdomen (cm)

Hip (cm)

Limbs (cm)

MUAC (cm)

11 NCD Risk Assessment

Not Applicable / Skip this section

Lifestyle & Dietary Habits

Eats Processed Food Weekly Eats Vegetables Daily Does Moderate Physical Activity

Diabetes Screening

Diagnosed with Diabetes Polyphagia (Excessive Hunger) Polydipsia (Excessive Thirst) Polyuria (Frequent Urination) Urine Ketone Positive Urine Protein Positive

Laboratory Values

FBS / RBS Value (mmol/L)

FBS / RBS Date

Cholesterol (mmol/L)

Cholesterol Date

Urine Ketone Date

Urine Protein Date

12 Cardiovascular Screening

Chest Pain Chest Center / Left Pain Pain When Walking Slows Down When in Pain Pain Relieved by Rest Pain Resolves Under 10 Minutes Severe Chest Pain

13 Stroke Screening

Difficulty Talking Limb Weakness Cyanosis Edema Decreased Mobility Pale Nailbeds

14 Cardiovascular Risk Level

Risk Level

Patient	PIN	Profiling Date	ATC	Walk-In	Eff. Year	Created
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—Total Patients

—Liveness Check ✓

—Care Agreement ✓

—Fully Complete

Patient	Age / Sex	PhilHealth No.	Member Type	Liveness Check	Care Agreement	Registered
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1 PhilHealth Member Lookup

Search by PhilHealth PIN, or by patient name and date of birth.

PhilHealth ID (PIN)

Last Name

First Name

Last Name

Birthdate

1 Visit Information

Patient

Screening Date

2 Vital Signs & Anthropometrics

BP Systolic (mmHg)

BP Diastolic (mmHg)

Heart Rate (bpm)

Respiratory Rate (/min)

Temperature (°C)

O₂ Saturation (%)

Height (cm)

Weight (kg)

BMI (auto)

Blood Type

3 Physical Examination

HEENT

Essentially Normal Abnormal pupillary reaction Dry mucous membrane Icteric sclerae Pale conjunctivae Sunken eyeballs Sunken fontanelle

Others:

Chest / Lungs

Heart / Cardiovascular

Abdomen

Genitourinary

Skin / Extremities

Neurological

Other Findings

4 Laboratory Results

Blood Sugar

FBS (mg/dL)

FBS (mmol/L)

RBS (mg/dL)

RBS (mmol/L)

CBC

WBC (×10³/µL)

RBC (×10⁶/µL)

Hemoglobin (g/dL)

Hematocrit (%)

Platelets (×10³/µL)

Lab Facility

Lab Remarks

5 Immunizations Given This Visit

Influenza Pneumococcal HPV Tetanus Toxoid Hepatitis B COVID-19 Booster

6 Assessment & Plan

New Conditions / Diagnoses

Assessment Notes

Referred?

NoYes

Referral Center

Follow-up Date

Patient	Date	BP	BMI	Assessment Notes	Referred
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1 Visit Information

Patient

Consultation Date

Transaction No.

Walked-in?

No (with OTP)Yes (Walk-in)

Patient Documents

Liveness Check

Screenshot or selfie photo

Choose File

Mutual Care Agreement

Signed agreement photo or PDF

Choose File

Documents are uploaded automatically when you save the consultation. Max 10 MB per file. JPG, PNG, PDF accepted.

S Subjective

Chief Complaints * At least one required

Cough Fever Headache Dizziness Chest Pain Shortness of Breath Abdominal Pain Nausea / Vomiting Fatigue / Weakness Joint Pain Back Pain Burning Urination

History of Present Illness *

Other Complaints / Pain Site

O Objective

Vital Signs

BP Systolic *

BP Diastolic *

Heart Rate (bpm) *

Respiratory Rate *

Temperature (°C) *

Height (cm) *

Weight (kg) *

BMI (auto)

Waist Circ. (cm)

Visual Acuity L

Visual Acuity R

Physical Examination by System

HEENT

Chest / Lungs

Heart

Abdomen

Genitourinary

Rectal Exam

Skin / Extremities

Neurological

A Assessment — Diagnoses

ICD-10 Code

Diagnosis Description

Type

P Plan

Diagnostic Orders

CBC FBS RBS Urinalysis Creatinine Lipid Profile ECG Chest X-ray OGTT Pap Smear HbA1c Others

Management / Treatment Plan

Referred?

NoYes

Referral Center

Referral Reason

Follow-up Date

Copayment (₱)

Patient	Date	BP	Chief Complaints	Assessment	Plan	Referred
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1 Lab Record Information

Patient

Lab Date

Lab Type

Lab Facility

Lab Fee (₱)

2 Results

Select a lab type above to enter results.

Glucose (mg/dL)

Glucose (mmol/L)

WBC (×10³/µL)

RBC (×10⁶/µL)

Hemoglobin (g/dL)

Hematocrit (%)

MCV (fL)

MCH (pg)

MCHC (g/dL)

Platelets (×10³/µL)

Neutrophils (%)

Lymphocytes (%)

Monocytes (%)

Eosinophils (%)

Color

Transparency

Specific Gravity

Protein

Glucose

RBC (/hpf)

WBC (/hpf)

Bacteria

Epithelial Cells

Total Cholesterol (mg/dL)

HDL-C (mg/dL)

LDL-C (mg/dL)

Triglycerides (mg/dL)

VLDL (mg/dL)

Rate (bpm)

Rhythm

Axis

ECG Findings / Impression

Findings

Impression

0 hr (FBS) mg/dL

1 hr mg/dL

2 hr mg/dL

Test Name

Result

Unit

Remarks / Interpretation

Patient	Date	Lab Type	Facility	Fee (₱)	Remarks
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1 Prescription Information

Patient

Prescription Date

2 Medicines

Medicine 1

Generic Name

Brand Name