911 narrative newest

Call Type: [text name="variable_1" default=""]

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Upon Arrival: [textarea name="variable_2" default=""]
Chief Complaint: [textarea name="variable_3" default=""]
Secondary Complaints: [textarea name="variable_4" default=""]
Pertinent Factors: [textarea name="variable_5" default=""]

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HPI:
Symptoms Current or Resolved: [checkbox name="variable_6" value="Current|Resolved"]
Onset: [text name="variable_7" default=""]
Provoking Factors: [text name="variable_8" default=""]
Relieving Factors: [text name="variable_9" default=""]
Quality: [text name="variable_10" default=""]
Location: [text name="variable_11" default=""]
Radiation: [text name="variable_12" default=""]
Severity: [select name="variable_13" value="0/10|1/10|2/10|3/10|4/10|5/10|6/10|7/10|8/10|9/10|10/10"]
Intermittent or Constant: [select name="variable_14" value="Intermittent|Constant"]
Acute / Chronic: [select name="variable_15" value="acute|chronic"]

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ROS:

Constitutional: [checkbox name="variable_16" value="normal|weight loss|sweats|fatigue|malaise|lethargy|abnormal sleeping pattern|abnormal appetite|fever|itch/rash|recent trauma|lumps/bumps|masses"]
Eyes: [checkbox name="variable_17" value="normal|UTO|visual changes| headache|eye pain|double vision|scotomas|floaters"]
HEENT: [checkbox name="variable_18" value="normal|UTO|runny nose|epistaxis|sinus pain|stuffy ears|ear pain|tinnitus|gingival bleeding|toothache|sore throat|odynophagia"]
Cardiovascular: [checkbox name="variable_19" value="normal|UTO|chest discomfort|chest palpitations|shortness of breath|exercise intolerance|PND|orthopnea|edema|faintness|loss of consciousness|claudication"]
Respiratory: [checkbox name="variable_20" value="normal|UTO|wet cough|dry cough|sputum|shortness of breath|wheeze|hemoptysis"]
Gastrointestinal: [checkbox name="variable_21" value="normal|abdominal discomfort|indigestion|bloating|cramping|loss of appetite / food intolerance|nausea|vomiting|diarrhea|constipation|obstipation|vomiting blood|hematochezia|melaena|tenesmus"]
Musculoskeletal: [checkbox name="variable_22" value="normal|UTO|pain|misalignment|stiffness|joint swelling|decreased ROM|crepitus|functional deficit|arthritis"]
Integumentary: [checkbox name="variable_23" value="normal|UTO|pruritus|rash|stria|lesions|wound|incisions|acanthosis nigricans|nodules|tumors|eczema|dryness|discoloration"]
Neurological: [checkbox name="variable_24" value="normal|UTO|acute change in mental status|change in sight|change in smell|change in hearing|change in taste|seizures|fainting|headache|paresthesia|numbness|unilateral weakness|poor balance|speech problems|cognitive change"]
Psychiatric: [checkbox name="variable_25" value="normal|UTO|depression|anxiety|difficulty concentrating|paranoia|anhedonia|lethargy|mania|acute change in mental status"]
Endocrine: [checkbox name="variable_26" value="normal|UTO|hypothyroid|hyperthyroid|diabetes|adrenal"]
Hematologic / Lymphatic: [checkbox name="variable_27" value="normal|UTO|anemia|purpura|petechiae|anticoagulant/antiplatelet therapy|hemophilia|past blood donation"]
Allergic / Immunologic: [checkbox name="variable_28" value="normal|UTO|anaphylaxis|swelling / pain at groin|swelling / pain at axilla|swelling / pain at neck|allergic response"]

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Exam:

General: [checkbox name="variable_29" value="No apparent distress|In distress"]
HEENT: [checkbox name="variable_30" value="normocephalic|atraumatic|PERRLA|EOM|lymphadenopathy|thyromegaly|bruit|pallor|oropharynx WNL|neck supple"]
Chest: [checkbox name="variable_31" value="normal breathing|non tender|labored breathing|fast breathing|irregular breathing|wheezing|rhonchi|rales|crackles|diminished"]
Cardiovascular: [checkbox name="variable_32" value="0 pulse|+1 pulse|+2 pulse|+3 pulse|+4 pulse|pulses equal|S1|S2|murmurs|gallops|rubs"]
Abdomen: [checkbox name="variable_33" value="soft / non tender / non distended|hard|distended|tender RUQ|tender LUQ|tender RLQ|tender LLQ|rebound tenderness|normal bowel sounds|absent bowel sounds|hyperactive bowel sounds|ascites"]
Extremities: [checkbox name="variable_34" value="normal|clubbing|cyanosis|edema"]
Neurological: [checkbox name="variable_35" value="normal|alert|verbal|painful|unresponsive|oriented to person|oriented to place|oriented to time|oriented to situation|not oriented to person|not oriented to place|not oriented to time|not oriented to situation|dull sensation intact in all extremities|dull sensation not intact in all extremities|sharp sensation intact in all extremities|sharp sensation not intact in all extremities|no facial droop|no arm drift|no speech deficit|equal grip strength|left sided facial droop|right sided facial droop|left sided arm drift|right sided arm drift|apraxia|dysarthria|dysphagia"]

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Monitor / Diagnostics:

[checkbox name="variable_36" value="NIBP|SPO2|Nasal ETCO2|Advanced Airway ETCO2"]

Blood Glucose: [text name="variable_37" default=""]

Temperature: [text name="variable_38" default=""]
Temperature Method: [checkbox name="variable_39" value="Oral|Axillary"]

ECG Rhythm: [textarea name="variable_40" default=""]

12 lead ECG: [textarea name="variable_41" default=""]

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Interventions:

Airway: [textarea name="variable_42" default=""]

Oxygen: [textarea name="variable_43" default=""]

IV Access: [textarea name="variable_44" default=""]

Medications: [textarea name="variable_45" default=""]

Trauma: [textarea name="variable_46" default=""]

Responses to Interventions: [textarea name="variable_47" default=""]

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Extrication: [text name="variable_48" default=""]

Transport position: [text name="variable_49" default=""]

Destination: [text name="variable_50" default=""]

Transport remarks: [textarea name="variable_51" default=""]