Isotretinoin Monitoring Visit Note

Date: [Date]

Patient: [Patient name and identifier]

Provider: [Provider name and credentials]

Visit Type: [in-person / telemedicine] (If telemedicine, briefly note examination limitations.)

Isotretinoin Course Summary

• Start Date: [Start date]
• Current Dose: [mg/day] ([mg/kg/day])
• Cumulative Dose to Date: [mg total] ([mg/kg]) (Calculate only if sufficient data are available.)
• Adherence: [Missed doses or issues since last visit]

Interval History & Safety Screen

[Brief narrative of acne response since last visit, including patient global assessment, flares, and lesion burden]

• Psychiatric screen (required each visit): Depression [yes / no]; Mood changes [yes / no]; Suicidal ideation [yes / no] (Record explicit yes/no responses. Do not infer absence if not asked. If any "yes," add details.)
• Warning signs: [Severe headache, vision changes, severe abdominal pain, rectal bleeding, or other concerning symptoms — document if present or explicitly denied]
• Mucocutaneous effects: [Cheilitis, xerosis, epistaxis, or other isotretinoin-related effects as reported]
• Medication review: [Vitamin A supplements, tetracyclines, alcohol use, and other relevant interactions — confirm reviewed]

iPLEDGE Compliance

(Include this section only for patients who can become pregnant; omit entirely otherwise.)

• Pregnancy Test: [date] — [negative / positive / pending] — [urine / serum] — [home / clinical]
• Contraception: [Primary and secondary methods, adherence] (If abstinence, document explicit commitment and timeframe.)
• Dispensing Status: iPLEDGE requirements met today? [yes / no] (If pregnancy test pending, note whether prescription is deferred.)

Objective

• Weight: [kg] (Date: [date])
• Skin Exam: [Distribution, morphology, scarring, isotretinoin-related findings] (Note limitations if telemedicine.)
• Labs: [Test name, date, result, fasting status if relevant, interpretation/trend for each resulted test] (Do not infer normal for tests not resulted.)

Assessment & Plan

Acne status: [improved / stable / worsened] — [brief rationale]

Dose decision: [continue / increase / decrease / hold / stop] at [mg/day] ([mg/kg/day]); cumulative dose updated to [mg total] ([mg/kg])

Adverse effects: [Management of active side effects, if any — dose adjustment, symptomatic treatment, referrals]

Lab abnormalities: [Action taken for abnormal results, if any — dietary counseling, repeat interval, dose adjustment, hold parameters]

Pregnancy risk management: [Pregnancy test verified, prescription authorized today — include only for patients who can become pregnant] (If positive or indeterminate, document immediate discontinuation and urgent referral.)

Supportive care: [Emollients, lip balm, sun protection, other recommendations discussed]

Counseling: [Topics covered — teratogenicity, blood donation, mental health warning signs, urgent GI symptoms, as applicable]

Follow-up: [Number] days

Time-based billing: Total time: [minutes] (Include only if time-based billing is used.)