General Pediatric Exams
[select name="variable_1" value="Newborn Male|Newborn Female|Male less than 1 Year|Female less than 1 Year|Male 1 to 4 Years|Female 1 to 4 Years|Male over 4 Years|Female over 4 Years|Sports Physical"] [conditional field="variable_1" condition="(variable_1).is('Newborn Male')"] [textarea name="variable_2" default="Skin: Normal turgor and without lesions."] [textarea name="variable_3" default="Eyes: Red reflex present bilaterally. Pupils equally round and reactive to light"] [textarea name="variable_4" default="Head: Normocephalic with age appropriate fontanelles."] [textarea name="variable_5" default="Peripheral Vessels: Normal pulses and perfusion."] [textarea name="variable_6" default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs."] [textarea name="variable_7" default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds."] [textarea name="variable_8" default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Nontender without rebound. No masses palpable. No distention."] [textarea name="variable_9" default="Genitalia: Normal male external genitalia. Testes descended bilaterally. No hernia present."] [textarea name="variable_10" default="Spine: Straight with no lesions."] [textarea name="variable_11" default="Joints: Hips with full range-of-motion; negative Barlow and Ortolani."] [textarea name="variable_12" default="Extremities: No clubbing, cyanosis, or edema. Normal upper and lower extremities."] [textarea name="variable_13" default="Mental Status: Alert, oriented, in no distress. Appropriate for age."] [textarea name="variable_14" default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."][/conditional][conditional field="variable_1" condition="(variable_1).is('Newborn Female')"] [textarea name="variable_15" default="Skin: Normal turgor and without lesions."] [textarea name="variable_16" default="Eyes: Red reflex present bilaterally. Pupils equally round and reactive to light"] [textarea name="variable_17" default="Head: Normocephalic with age appropriate fontanelles."] [textarea name="variable_18" default="Peripheral Vessels: Normal pulses and perfusion."] [textarea name="variable_19" default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs."] [textarea name="variable_20" default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds."] [textarea name="variable_21" default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Nontender without rebound. No masses palpable. No distention."] [textarea name="variable_22" default="Genitalia: Normal female external genitalia. No hernia present."] [textarea name="variable_23" default="Spine: Straight with no lesions."] [textarea name="variable_24" default="Joints: Hips with full range-of-motion; negative Barlow and Ortolani."] [textarea name="variable_25" default="Extremities: No clubbing, cyanosis, or edema. Normal upper and lower extremities."] [textarea name="variable_26" default="Mental Status: Alert, oriented, in no distress. Appropriate for age."] [textarea name="variable_27" default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."][/conditional][conditional field="variable_1" condition="(variable_1).is('Male less than 1 Year')"] [textarea name="variable_28" default="General: Child appears age appropriate. Vitals noted and stable."] [textarea name="variable_29" default="Skin: Normal turgor and without lesions."] [textarea name="variable_30" default="Head: Normocephalic with age appropriate fontanelles."] [textarea name="variable_31" default="Eyes: Conjunctivae noninjected; sclerae anicteric; lids without ptosis, edema, or erythema; extraocular movements intact; pupils equal, round, and reactive to light. Red reflex present bilaterally."] [textarea name="variable_32" default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."] [textarea name="variable_33" default="Lymph Nodes: No significant lymphadenopathy."] [textarea name="variable_34" default="Thyroid: No thyromegaly; trachea midline without masses."] [textarea name="variable_35" default="Breasts: Without lesions or drainage."] [textarea name="variable_36" default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs. Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Extremities are warm and well perfused and capillary refill is less than 2 seconds."] [textarea name="variable_37" default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."] [textarea name="variable_38" default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."] [textarea name="variable_39" default="Genitalia: Normal male external genitalia; testes descended bilaterally; no hernia."] [textarea name="variable_40" default="Spine: Straight with no lesions."] [textarea name="variable_41" default="Joints: Full range of motion about all joints."] [textarea name="variable_42" default="Extremities: Digits and nails are normal"] [textarea name="variable_43" default="Gait: Normal and appropriate gait for age."] [textarea name="variable_44" default="Mental Status: Alert, oriented, in no distress. Appropriate for age."] [textarea name="variable_45" default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."] [textarea name="variable_46" default=""][/conditional][conditional field="variable_1" condition="(variable_1).is('Female less than 1 Year')"] [textarea name="variable_47" default="General: Child appears age appropriate. Vitals noted and stable."] [textarea name="variable_48" default="Skin: Normal turgor and without lesions."] [textarea name="variable_49" default="Head: Normocephalic with age appropriate fontanelles."] [textarea name="variable_50" default="Eyes: Conjunctivae noninjected; sclerae anicteric; lids without ptosis, edema, or erythema; extraocular movements intact; pupils equal, round, and reactive to light. Red reflex present bilaterally."] [textarea name="variable_51" default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."] [textarea name="variable_52" default="Lymph Nodes: No significant lymphadenopathy."] [textarea name="variable_53" default="Thyroid: No thyromegaly; trachea midline without masses."] [textarea name="variable_54" default="Breasts: Without lesions or drainage."] [textarea name="variable_55" default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs. Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Extremities are warm and well perfused and capillary refill is less than 2 seconds."] [textarea name="variable_56" default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."] [textarea name="variable_57" default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."] [textarea name="variable_58" default="Genitalia: Normal female external genitalia."] [textarea name="variable_59" default="Spine: Straight with no lesions."] [textarea name="variable_60" default="Joints: Full range of motion about all joints."] [textarea name="variable_61" default="Extremities: Digits and nails are normal"] [textarea name="variable_62" default="Gait: Normal and appropriate gait for age."] [textarea name="variable_63" default="Mental Status: Alert, oriented, in no distress. Appropriate for age."] [textarea name="variable_64" default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."] [textarea name="variable_65" default=""][/conditional][conditional field="variable_1" condition="(variable_1).is('Male 1 to 4 Years')"] [textarea name="variable_66" default="General: Child appears age appropriate. Vitals noted and stable."] [textarea name="variable_67" default="Skin: Normal turgor and without lesions."] [textarea name="variable_68" default="Head: Normocephalic."] [textarea name="variable_69" default="Eyes: Conjunctivae noninjected; sclerae anicteric; lids without ptosis, edema, or erythema; extraocular movements intact; pupils equal, round, and reactive to light. Red reflex present bilaterally. Symmetric light reflex."] [textarea name="variable_70" default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."] [textarea name="variable_71" default="Lymph Nodes: No significant lymphadenopathy."] [textarea name="variable_72" default="Thyroid: No thyromegaly; trachea midline without masses."] [textarea name="variable_73" default="Breasts: Without lesions or drainage."] [textarea name="variable_74" default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs. Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Extremities are warm and well perfused and capillary refill is less than 2 seconds."] [textarea name="variable_75" default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."] [textarea name="variable_76" default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."] [textarea name="variable_77" default="Genitalia: Normal male external genitalia; testes descended bilaterally; no hernia."] [textarea name="variable_78" default="Spine: Straight with no lesions."] [textarea name="variable_79" default="Joints: Full range of motion about all joints."] [textarea name="variable_80" default="Extremities: Digits and nails are normal"] [textarea name="variable_81" default="Gait: Normal and appropriate gait for age."] [textarea name="variable_82" default="Mental Status: Alert, oriented, in no distress. Appropriate for age."] [textarea name="variable_83" default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."] [textarea name="variable_84" default=""][/conditional][conditional field="variable_1" condition="(variable_1).is('Female 1 to 4 Years')"] [textarea name="variable_85" default="General: Child appears age appropriate. Vitals noted and stable."] [textarea name="variable_86" default="Skin: Normal turgor and without lesions."] [textarea name="variable_87" default="Head: Normocephalic."] [textarea name="variable_88" default="Eyes: Conjunctivae noninjected; sclerae anicteric; lids without ptosis, edema, or erythema; extraocular movements intact; pupils equal, round, and reactive to light. Red reflex present bilaterally. Symmetric light reflex."] [textarea name="variable_89" default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."] [textarea name="variable_90" default="Lymph Nodes: No significant lymphadenopathy."] [textarea name="variable_91" default="Thyroid: No thyromegaly; trachea midline without masses."] [textarea name="variable_92" default="Breasts: Without lesions or drainage."] [textarea name="variable_93" default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs. Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Extremities are warm and well perfused and capillary refill is less than 2 seconds."] [textarea name="variable_94" default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."] [textarea name="variable_95" default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."] [textarea name="variable_96" default="Genitalia: Normal female external genitalia."] [textarea name="variable_97" default="Spine: Straight with no lesions."] [textarea name="variable_98" default="Joints: Full range of motion about all joints."] [textarea name="variable_99" default="Extremities: Digits and nails are normal"] [textarea name="variable_100" default="Gait: Normal and appropriate gait for age."] [textarea name="variable_101" default="Mental Status: Alert, oriented, in no distress. Appropriate for age."] [textarea name="variable_102" default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."][/conditional][conditional field="variable_1" condition="(variable_1).is('Male over 4 Years')"] [textarea name="variable_103" default="General: Child appears age appropriate. Vitals noted and stable."] [textarea name="variable_104" default="Skin: Normal turgor and without lesions."] [textarea name="variable_105" default="Head: Normocephalic."] [textarea name="variable_106" default="Eyes: Conjunctivae noninjected; sclerae anicteric; lids without ptosis, edema, or erythema; extraocular movements intact; pupils equal, round, and reactive to light. Symmetric light reflex, normal fundi."] [textarea name="variable_107" default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."] [textarea name="variable_108" default="Lymph Nodes: No significant lymphadenopathy."] [textarea name="variable_109" default="Thyroid: No thyromegaly; trachea midline without masses."] [textarea name="variable_110" default="Breasts: Without lesions or drainage."] [textarea name="variable_111" default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs. Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Extremities are warm and well perfused and capillary refill is less than 2 seconds."] [textarea name="variable_112" default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."] [textarea name="variable_113" default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."] [textarea name="variable_114" default="Genitalia: Normal male external genitalia; testes descended bilaterally; no hernia."] [textarea name="variable_115" default="Spine: Straight with no lesions."] [textarea name="variable_116" default="Joints: Full range of motion about all joints."] [textarea name="variable_117" default="Extremities: Digits and nails are normal"] [textarea name="variable_118" default="Gait: Normal and appropriate gait for age."] [textarea name="variable_119" default="Mental Status: Alert, oriented, in no distress. Appropriate for age."] [textarea name="variable_120" default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."][/conditional][conditional field="variable_1" condition="(variable_1).is('Female over 4 Years')"] [textarea name="variable_121" default="General: Child appears age appropriate. Vitals noted and stable."] [textarea name="variable_122" default="Skin: Normal turgor and without lesions."] [textarea name="variable_123" default="Head: Normocephalic."] [textarea name="variable_124" default="Eyes: Conjunctivae noninjected; sclerae anicteric; lids without ptosis, edema, or erythema; extraocular movements intact; pupils equal, round, and reactive to light. Symmetric light reflex, normal fundi."] [textarea name="variable_125" default="ENT: TMs gray, sharp landmarks, mobile. Nose clear. Palate is complete. Dentition normal for age. Tonsils small and non-inflamed bilaterally."] [textarea name="variable_126" default="Lymph Nodes: No significant lymphadenopathy."] [textarea name="variable_127" default="Thyroid: No thyromegaly; trachea midline without masses."] [textarea name="variable_128" default="Breasts: Without lesions or drainage."] [textarea name="variable_129" default="Heart: Regular rate and rhythm; normal S1 and S2; no murmurs, gallops, or rubs. Peripheral pulses are equal. There is no clubbing, cyanosis or edema of the extremities. Extremities are warm and well perfused and capillary refill is less than 2 seconds."] [textarea name="variable_" default="Lungs: Unlabored respirations; symmetric chest expansion; clear breath sounds; no wheezes, crackles, rales, rhonchi, or retractions."] [textarea name="variable_130" default="Abdomen: Soft, without organomegaly. Bowel sounds normal. Non-tender without rebound. No masses palpable. No distention."] [textarea name="variable_131" default="Genitalia: Normal female external genitalia."] [textarea name="variable_132" default="Spine: Straight with no lesions."] [textarea name="variable_133" default="Joints: Full range of motion about all joints."] [textarea name="variable_134" default="Extremities: Digits and nails are normal"] [textarea name="variable_135" default="Gait: Normal and appropriate gait for age."] [textarea name="variable_136" default="Mental Status: Alert, oriented, in no distress. Appropriate for age."] [textarea name="variable_137" default="Neuro: Normal reflexes; normal tone; no focal deficits appreciated. Appropriate for age."][/conditional][conditional field="variable_1" condition="(variable_1).is('Sports Physical')"] [textarea name="variable_138" default="GENERAL: The patient is well developed, well nourished, alert and cooperative and appears to be in no acute distress. Vital signs as noted."] [textarea name="variable_139" default="EYES: Normal eye and funduscopic exam."] [textarea name="variable_140" default="VISION SCREEN: right eye 20/20, left eye 20/20"] [textarea name="variable_141" default="EAR, NOSE, AND THROAT: Ear canals and tympanic membranes are clear, and hearing is grossly intact. Nose revels no obstruction or discharge. Oropharynx reveals no inflammation, swelling, exudate, or lesion. Lips, teeth, and gums are in good general condition."] [textarea name="variable_142" default="NECK: No thyromegaly."] [textarea name="variable_143" default="LYMPH: No adenopathy."] [textarea name="variable_144" default="RESPIRATORY: Lungs are clear to auscultation and percussion without rales, rhonchi, wheezing, rub diminished breath sounds, or labored breathing."] [textarea name="variable_145" default="HEART: Regular rhythm with no significant murmurs, rubs, gallops, or clicks."] [textarea name="variable_146" default="ABDOMEN: Abdomen is soft, nontender without masses, hepatosplenomegaly, or abnormal pulsation. There is no guarding or tenderness."] [textarea name="variable_147" default="GENITALIA: Normal and age appropriate."] [textarea name="variable_148" default="MUSCULOSKELETAL: Examination shows no significant weakness or deformity of the musculoskeletal system. Can perform duck walk and heel-toe walk."] [textarea name="variable_149" default="SKIN: Normal, without rash or lesion."][/conditional]
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Sandbox Metrics: Structured Data Index 0.01, 159 form elements, 149 text areas, 1 drop downs, 9 conditionals, 150 total clicks
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