Biologic Therapy Follow-Up Note (Asthma, Atopic Dermatitis, or Urticaria)

Date: [Encounter date]

Patient: [Patient name and identifiers per local policy]

Provider: [Rendering clinician]

Condition(s): [asthma / atopic dermatitis / chronic urticaria] (List all applicable indications being treated)

Biologic: [Biologic name] — [dose] [route], [frequency]; Start date: [date]

Reason for Visit

[Brief statement indicating this is a biologic therapy follow-up for the listed condition(s) and whether the visit supports payer re-authorization]

Re-Authorization Summary

Baseline severity: [Date] — [Baseline metric(s) relevant to treated condition(s)] (If unavailable, state: Not available—[reason])

Current status: [Today's date] — [Current metric(s) relevant to treated condition(s)]

Clinical benefit: [Summary of improvements since therapy initiation with explicit timeframe]

Adverse effects: [None reported / Significant effect(s): description] — Source: [patient report / chart review / other]

Adherence: [Consistent use / Missed doses: number / Administration issues: description] — Source: [patient report / pharmacy data / injection logs]

Continuation rationale: [Single sentence linking ongoing indication, demonstrated clinical benefit, acceptable safety, and reassessment plan]

Interval History

Time on therapy: [Duration since start]

Administration: Setting: [home / clinic]; Last dose: [date]; Next planned dose: [date]; Administration issues: [none / description]

Concomitant therapies: [Relevant controller, rescue, or topical therapies] (Include changes with dates if applicable)

Adverse effects since last visit: [No adverse effects reported / description with onset and course] — Source: [patient report / chart review]

Asthma interval control (Include only if asthma is a treated condition)

• Timeframe: [past ___ weeks / months / since last visit]
• Daytime symptoms: [frequency / none]
• Nighttime awakenings: [frequency / none]
• Activity limitation: [yes / no]; [details if yes]
• Rescue inhaler use: [uses per week / none]
• Exacerbations: ED visits [number], hospitalizations [number]
• Oral corticosteroid exposure: Maintenance [dose and duration / none]; Bursts [number and dates / none]

Atopic dermatitis interval course (Include only if atopic dermatitis is a treated condition)

• Timeframe: [past ___ weeks / months / since last visit]
• Flares: [frequency and severity]
• Itch severity: [descriptor or score]
• Sleep disruption: [yes / no]; [details if yes]
• Affected areas: [distribution]
• Topical therapy intensity: [frequency and potency]

Chronic urticaria interval course (Include only if chronic urticaria is a treated condition)

• Timeframe: [past ___ weeks / months / since last visit]
• Wheal frequency: [frequency / none]
• Angioedema episodes: [number and locations / none]
• Breakthrough symptoms: [present / absent]; [details if present]
• Rescue medication needs: [frequency and type / none]

Objective

Vitals: [Weight, SpO2, other relevant vitals] (If not available, state reason)

Physical exam:

• Respiratory (asthma): [lungs clear / wheeze / crackles / other findings]
• Skin (atopic dermatitis): [distribution, morphology, lichenification, excoriations / no active lesions]
• Skin (urticaria): [wheals present / absent]; [angioedema present / absent]

(Include only systems pertinent to treated condition(s); document normal findings explicitly)

Data reviewed:

• Spirometry: [date, source, key values and interpretation / not available—reason]
• Validated outcome score(s): [name, value, date, source / not assessed]
• Biomarker(s): [name, value, date, source / not indicated]
• Pharmacy fill history: [date range, source, summary / not available]

Assessment and Plan

(Organize by each biologic-treated condition; use explicit timeframes when citing outcomes)

Asthma

(Include only if applicable)

Control classification: [well-controlled / partially controlled / uncontrolled]

Response to biologic: [good / partial / unclear / no response]

Medical necessity statement: [Confirmation that indication persists, specific benefit metrics with timeframe, acceptable safety profile, and reassessment plan]

• Biologic plan: [Continue / adjust / hold] [biologic name] — [dose, route, frequency]; Rationale: [justification]
• Adjunct therapy: [Controller adjustments, rescue plan, device technique]
• Steroid plan: [None / taper or initiation details with rationale]
• Monitoring: [Planned tests, scores, timing, adverse effect surveillance]
• Follow-up: [3 / 4 / 6 months] or sooner if worsening
• Return precautions: [Hypersensitivity signs, infection concerns, worsening control]

Atopic Dermatitis

(Include only if applicable)

Current severity: [mild / moderate / severe]; [controlled / partially controlled / uncontrolled]

Response to biologic: [good / partial / unclear / no response]

Medical necessity statement: [Confirmation that indication persists, specific benefit metrics with timeframe, acceptable safety profile, and reassessment plan]

• Biologic plan: [Continue / adjust / hold] [biologic name] — [dose, route, frequency]; Rationale: [justification]
• Adjunct therapy: [Topical regimen adjustments, antipruritic measures]
• Steroid plan: [None / topical or systemic plan with rationale]
• Monitoring: [Planned scores, skin assessments, adverse effect surveillance]
• Follow-up: [3 / 4 / 6 months] or sooner if worsening
• Return precautions: [Hypersensitivity signs, infection concerns, worsening inflammation]

Chronic Urticaria

(Include only if applicable)

Current control: [well-controlled / partially controlled / uncontrolled]

Response to biologic: [good / partial / unclear / no response]

Medical necessity statement: [Confirmation that indication persists, specific benefit metrics with timeframe, acceptable safety profile, and reassessment plan]

• Biologic plan: [Continue / adjust / hold] [biologic name] — [dose, route, frequency]; Rationale: [justification]
• Adjunct therapy: [Antihistamine regimen, add-ons or step-down plan]
• Steroid plan: [None / short course plan with rationale]
• Monitoring: [Planned scores, labs if indicated, adverse effect surveillance]
• Follow-up: [3 / 4 / 6 months] or sooner if worsening
• Return precautions: [Hypersensitivity signs, infection concerns, angioedema with airway involvement]

(If key information is missing, document as Unknown, Not assessed, or Not available—[reason] rather than leaving blank)