Risk Factor Assessment
Ask the patient about the following risk factors.
Yes
No
Yes
No
Yes
No
Yes
No
Hep C Status Check
Check patient's Hep C history.
⚠
Please screen NEHR once consent is given by the patient.
Yes
No
Reactive
Negative
Unknown
Not tested
Past Medical History
Paste from NEHR and the tool will clean up formatting.
⚠
Please screen NEHR once consent is given by the patient.
Red Flag / Key Symptoms
Ask the patient about the following symptoms.
None
Fatigue / Appetite / Weight loss
Jaundice / Yellow eyes
Swelling (legs / Ascites)
Vomiting blood or black stools
Alcohol History & CHAS
Assess alcohol use and subsidies.
Yes
No
Green
Blue
Orange
Merdeka
Pioneer
NA
Physical Examination
Focused exam: assess for chronic liver disease signs.
🔍
Look for signs of chronic liver disease.
None
Yellow eyes (Jaundice)
Abdominal swelling (Ascites)
Leg swelling (Oedema)
Others (chronic liver signs)
Review & Copy
Review the generated text, then copy to SGIMed.
✎
You can edit the text below before copying.
Generated Template