TELEPHONE ENCOUNTER NOTE

Patient: [Name]
Date of birth: [Date]
Date and time of call: [Date, time the call came in, and time of any return call]
Call type: [Incoming call, return call, after-hours line, or message follow-up]
Taken by: [Name, credentials, role]

CALLER
Caller: [Patient, or name and relationship to the patient]
Authority to discuss: [Patient on the line, parent or guardian, or contact the patient has authorized]
Identity checked: [Patient's full name and date of birth, plus one more identifier]
Callback number: [Number, read back to the caller]
Patient location now: [Home, work, or street address, in case emergency services are needed]
Language: [Language used, interpreter name or ID, or none needed]

REASON FOR CALL
Concern: [The main concern, in the caller's words]
Onset and course: [When it started, how it has changed, what has been tried, with doses and times]
Relevant history: [Conditions, medications, allergies, pregnancy, recent visits or surgery]

TRIAGE
Protocol used: [Protocol name from your triage protocol set, or clinician-directed]
Red flags asked: [Each emergency question and the answer, present or absent]
Other answers: [Positive and negative answers that set the disposition]
Readings reported: [Temperature, weight, BP, glucose, or other home readings, with the device and time]

ADVICE AND DISPOSITION
Disposition: [Call 911 now, emergency department now, same-day visit, appointment within 24 hours or later, or home care]
Change from protocol: [None, or the new disposition, the reason, and who agreed]
Advice given: [Home care, any dose worked out by weight or age, and what to avoid]
Warning signs: [Signs that mean call back, and signs that mean call 911, named for this problem]
Prescription or result action: [Refill request, result discussed, or none; details go in their own note]
Appointment: [Date, time, clinician, in person or video, or none]

CONSULTATION
Clinician consulted: [Name, time, and the advice or order given, or none]
Orders read back: [Yes, with the order, or not applicable]
Escalation: [Who was told, by what route, and when]

CLOSE OF CALL
Caller's understanding: [Plan repeated back by the caller, and their agreement]
Call-back plan: [Who calls whom, by when, and what happens if there is no answer]
Call ended: [Time, and how: caller hung up, transferred, or paramedics arrived]

Signed: [Name, credentials, date and time]