Patient-Reported Outcome Review Note (PROMIS/PROs)

Date: [Date of review]
Patient: [Patient name and identifier]
Provider: [Clinician name and credentials]
Encounter Type: [in-person / telehealth / asynchronous chart review]
Clinical Context: [Clinical context for PRO collection/review] (Keep concise; e.g., pre-op baseline, chronic disease follow-up, treatment monitoring.)

PRO Review Context

[Reason for PRO collection/review and goal] (State whether this is routine monitoring, symptom flare, treatment change, or quality program; specify goal such as establishing baseline or assessing treatment response; note whether results inform clinical decisions today or serve as trend data only. 1–3 sentences.)

Instruments Reviewed: [Instrument names with administration dates] (If data quality concerns exist, note briefly inline—e.g., incomplete responses, version differences between timepoints, proxy respondent. If no concerns, list instruments and dates only.)

Results & Interpretation

(Present patient-reported scores first; keep clinician judgments separate in the interpretation paragraph.)

• [Domain name] [higher=better / higher=worse]: [Current score with metric type, e.g., T-score]; [Severity category if local cut points adopted]; Prior: [score, date] if available; Change: [magnitude and direction]
• (Repeat for each domain/instrument reviewed.)

Clinician Interpretation: [Interpretation of patterns and change] (Indicate whether observed changes meet a clinically meaningful threshold—cite threshold used or state significance is uncertain. Note concordance or discordance with patient narrative and exam findings, and any cross-domain patterns. For baseline measurements with no prior data, explicitly state that today's scores establish baseline. Do not imply causation without supporting evidence.)

Plan

• [Problem/Issue]: PRO Evidence: [Domain, score, trend]; Assessment: [Clinical interpretation linked to PRO findings]; Actions: [Medication changes, therapy, referrals, diagnostics, counseling, safety interventions, or rationale for no change]
• (Repeat for each clinically relevant finding informed by PROs.)

Follow-up PRO Plan: [Timing of next PRO collection]; [Instruments/domains to repeat]; [Threshold-based escalation instructions per local protocol] (Specify collection modality and reviewer if relevant.)

(If any PRO indicates urgent concerns—e.g., severe symptom burden or safety issues—document immediate response per institutional protocol. When instrument version, recall period, or scoring method is unavailable, record as "not available in record" rather than inferring.)