Fever Clerking Template
History & Physical Examination → Structured Note
Patient Details
Age (years)
Weight (kg)
Allergy History
Underlying Conditions
Occupation
History of Presenting Illness
Fever?
Select...
Yes
No
Duration (Days)
Tmax (°C)
Symptoms (Select all that apply)
Cough
Runny Nose
Sore Throat
Vomiting
Nausea
Diarrhea
Abdominal Pain
Ear Ache
Headache
Myalgia
Cough Details
Type
Dry
Productive
Runny Nose (Days)
Sore Throat (Days)
Headache (Days)
Myalgia (Days)
Vomiting (Days / Freq)
Nausea (Days)
Diarrhea Details
Type
Watery
Semi-solid
Blood in stool
Abdominal Pain Characteristics
Nature
Select
Colicky
Continuous
Location
Select
Epigastric
Central (periumbilical)
RIF
LUQ
RLQ
Generalized
Days
Migration of pain to RLQ/RIF?
Select
No
Yes
Ear Symptoms
Reduced hearing?
No
Yes
Ear discharge?
None
Water coming out from ear
Pus coming out from ear
Headache (Days)
Myalgia (Days)
Oral intake
Select
Normal
Reduced
Poor
Unable
Anorexia?
Select
No
Yes
Bleeding tendency
Select
None
Easy bruising
Gum bleed
Nose bleed
Other
Travel history (recent)
Home tests
Select
None
Influenza negative
Influenza positive
COVID-19 negative
COVID-19 positive
Residence risk
Select
Not dengue/outbreak area
Lives in dengue area
Lives in outbreak area
Examination
Alertness
Select
Alert
Lethargic
Drowsy
Confused
Perfusion (Pink)
Select
Yes (well perfused)
No (pale/cyanotic)
CRT
Select
< 2s
≥ 2s
Peripheries
Select
Warm
Cold
Tongue
Select
Moist
Coated
Dry
Temperature (°C)
Rashes?
Select
None
Present
Rash location
Throat Injected?
Select
No
Yes
Tonsils Enlarged?
Select
No
Yes
Tonsillar Exudate?
Select
No
Yes
Tender Ant. Cerv. Nodes?
Select
No
Yes
Ear Examination
Select
TM normal
TM bulging and erythematous
Pus in ear canal
Perforated tympanic membrane
Lungs
Select
Clear
Crackles
Wheeze
Reduced air entry
Bronchial breath sounds
CVS
Per Abdomen
Select
Soft, non tender
RIF tenderness
Rebound tenderness?
Select
No
Yes
Modified Centor (McIsaac) Score
Criteria: fever (history or Tmax ≥38°C), tonsillar exudate, tender anterior cervical nodes, absence of cough; age adj: +1 (3–14), 0 (15–44), –1 (≥45).
Calculate
Investigation
Full Blood Count (Paste report text below)
Extract Values
Clinical Scores
Modified Centor (McIsaac) Score
Criteria: fever history or Tmax >=38°C, tonsillar exudate, tender anterior cervical nodes, absence of cough; age adjustment: +1 (3-14), 0 (15-44), -1 (>=45).
Calculate
Alvarado Score
Criteria: migration to RLQ/RIF, anorexia, nausea/vomiting, RIF tenderness, rebound tenderness, temperature >=37.3°C, leukocytosis, neutrophils >75%.
Calculate
Plan & Dosing
Medications & Orders
Syr PCM (15 mg/kg TDS)
Syr Chlorpheniramine (0.1 mg/kg TDS)
Syr Promethazine (FUKKM)
Syr Diphenhydramine (FUKKM)
Syr Amoxicillin (NAG MOH)
Tonsillitis / Pharyngitis
Acute otitis media
Encourage oral fluids
FBC if fever > 3 days
TCA STAT if worsening sx
Dosing Preview
Impression & Note
Impression
Generated Note
Generate Note
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Template Logic Info
FBC paste-&-extract → shows Hb, hct, plt, TWC only.
Modified Centor score alerts purple if score ≥4.
Promethazine and diphenhydramine dosing references FUKKM.
Amoxicillin dosing changes by indication and references NAG MOH.
Bold headings preserved when copying to Word.