pediatric chronic abdominal pain (2+ mos)

[text name="age" memo="age"] year old [select name="variable_1" value="male|female"] here for [text name="duration" memo="duration"] of [select name="variable_1" value="improving|worsening|stable"] 
[text memo="location"] [select name="variable_1" value="radiating|non-radiating|"] abdominal pain. Pain occurs [text name="frequency" memo="frequency"] and lasts [text memo="how long"]. Pain is described as [text memo="description (ie sharp)"]. On average, pt rates pain as a [text memo="#"] out of 10; at its worst, it is a [text memo="#"] out of 10.

Alleviated by [checkbox value="eating |laying down|sitting up|spicy foods|fast food|being in a specific position"][textarea name="variable_1" default=""]

Made worse by [checkbox value="eating | laying down|sitting up|spicy foods|fast food|being in a specific position"][textarea name="variable_1" default=""] 

Pain [select value="does|does not"] wake patient from sleep, [select value="is|is not"] worst in the early morning. 

[textarea name="variable_1" default="Denies that pain seems to be related to menstrual cycle"]

Vomiting:
Vomiting [select value="never occurs|is rarely associated with the abdominal pain|is sometimes associated with the abdominal pain|is always associated with the abdominal pain"]. It is [select value="nonbilious|bilious"], [select value="nonbloody|bloody"], and [select value="not projectile|projectile"]. On average, patient reports vomiting [text memo="frequency"]

Constipation: 
Patient reports bowel movements [text memo="how often"]. [select value="Endorses|Denies"] straining with BMs. [select value="Endorses|Denies"] a sensation of incomplete emptying, and [select value="Endorses|Denies"] stools that clog the toilet. [select value="Endorses|Denies"] painful stools. 
[textarea name="variable_1" default=""]


Surgical History: 
[textarea name="variable_1" default=""]

Social History: [select value="Endorses|Denies"] recent travel. [select value="Endorses|Denies"] smoking pot. [select value="Is not|Is"] sexually active. 
[textarea name="variable_1" default="Usually uses condoms"]


Family History: [checkbox value="IBD|celiac disease|PUD"]

ROS:
[checkbox value="nausea|vomiting|diarrhea|soiling self|black/bloody stools|sour breath|burping|feeling gassy|bloating|decreased appetite|rectal pain|dysmenorrhea|rashes|trouble/painful swallowing|feeling fully early|frequent oral ulcers|dysuria|urinary urgency|hematuria|back pain |unintentional weight loss|"]


Red Flags? 
[checkbox value="involuntary weight loss|unexplained fever|difficulty swallowing or painful swallowing|vomiting that is bilious, protracted, projectile, or otherwise worrisome|diarrhea that is severe and chronic (≥3 loose or watery stools per day for ≥2 weeks),nocturnal, or bloody|urinary symptoms|back pain|family history of inflammatory bowel disease (IBD), celiac disease, or peptic ulcer disease|skin changes (eg, rash, eczema, hives)"]
age year old here for duration of
location abdominal pain. Pain occurs frequency and lasts how long. Pain is described as description (ie sharp). On average, pt rates pain as a # out of 10; at its worst, it is a # out of 10.

Alleviated by

Made worse by

Pain wake patient from sleep, worst in the early morning.



Vomiting:
Vomiting . It is , , and . On average, patient reports vomiting frequency

Constipation:
Patient reports bowel movements how often. straining with BMs. a sensation of incomplete emptying, and stools that clog the toilet. painful stools.



Surgical History:


Social History: recent travel. smoking pot. sexually active.



Family History:

ROS:



Red Flags?

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.57, 37 form elements, 93 boilerplate words, 10 text boxes, 6 text areas, 5 checkboxes, 16 drop downs, 78 total clicks
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