Heart Failure CCM Notes
Heart Failure Chronic Care Management Note Heart Failure Type: [select name="Heart_Failure_Type" value="Systolic (reduced ejectiion fraction)|Diastolic (presevered ejection fraction)|Unknown"] Date of last echocardiogram: [date name="echo_date" default="01/19/2022"] Ejection fraction: [text name="EF" default="%"] Heart failure medications Beta-blocker [checklist name="beta_blocker" value="bisoprolol|carvedilol|metoprolol succinate|not on an evidence-based beta blocker"] [conditional field="dose" condition="beta_blocker"value="bisoprolol|carvedilol|metoprolol succinate"] any text to display if condition is true [/conditional] Current dose: [text name="beta_blocker_dose" default="mg daily"] [comment memo="Target doses: bisoprolol 10mg daily, carvedilol 25 mg twice daily for weight <85 kg and 50 mg twice daily for weight >85 kg, metoprolol 200mg daily"] [select name="beta_blocker_dose" value="choice A|choice B|choice C"]
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Sandbox Metrics: Structured Data Index 0.67, 8 form elements, 21 boilerplate words, 2 text boxes, 1 dates, 1 check lists, 2 drop downs, 1 comments, 1 conditionals, 9 total clicks
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