Palpitations History
Palpitations Onset [text] prior to evaluation Onset while: [text] Discomfort (0=none, 10=severe) Location: [text] Radiation: [text] Severity now (0-10): [text] Severity at worst (0-10): [text] Duration: [text] Frequency: [text] Characterized as: [text]. Modifiers Relieved with [text] Worse with [text] [text] exertional Key Symptoms [select value="no|YES"] <-- rapid heart beat [select value="no|YES"] <-- slow heart beat [select value="no|YES"] <-- irregular heart beat Associated Symptoms [select value="no|YES"] <-- Complete Loss of Consciousness [select value="no|YES"] <-- Near loss of consciousness [select value="no|YES"] <-- chest pain [select value="no|YES"] <-- shortness of breath [select value="no|YES"] <-- hyperventilation (lip numbness, hand paresthesias) [select value="no|YES"] <-- Falls Exposures [select value="no|YES"] <-- Low blood sugar [select value="no|YES"] <-- Excessive alcohol [select value="no|YES"] <-- Drug abuse [select value="no|YES"] <-- Caffeine Pertinent ROS [select value="no|YES"] <-- fever [select value="no|YES"] <-- dizziness [select value="no|YES"] <-- cough [select value="no|YES"] <-- nausea/vomiting [select value="no|YES"] <-- abdominal pain [select value="no|YES"] <-- abnormal bleeding (menorrhagia, gastrointestinal) [select value="no|YES"] <-- unilateral leg swelling [select value="no|YES"] <-- recent prolonged travel, recent trauma, hypercoagulable state, hormonal therapy Pertinent PMH: [select value="no|YES"] <-- Arrhythmia [select value="no|YES"] <-- Pacemaker [select value="no|YES"] <-- Valve Disorder [select value="no|YES"] <-- Coronary Artery Disease [select value="no|YES"] <-- Thyroid disease [select value="no|YES"] <-- Diabetes Mellitus [select value="no|YES"] <-- Anxiety disorder [select value="no|YES"] <-- COPD [checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"] reference: contributed by Dr. Scott Moses, creator/author of the Family Practice Notebook [link url="//www.fpnotebook.com" memo="fpnotebook.com"] [/conditional]
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