Post-Treatment Respiratory Check

Code from chart · WRK-011

Clinical chart

Signed note

Signed encounter note

DOS · 2026-10-20Assignment · WRK-011Setting · Outpatient physician office

Reason for visit

Follow-up visit after completed treatment for community-acquired pneumonia.

Interval history

The antibiotic course was completed. Fever, cough, and shortness of breath have resolved, and the patient has returned to usual activity. The patient reports no new respiratory concern.

Findings

Afebrile. Lungs are clear bilaterally with normal work of breathing. Oxygen saturation and respiratory rate are within the expected range.

Assessment and plan

Pneumonia has resolved; treatment is complete and no residual disease is present. No additional treatment is planned. Continue routine surveillance. Personal history is updated to reflect the prior pneumonia.

Coding workbench

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