Communication Template

[comment memo="Family Communication"]
[checkbox name="Problem2" value="Patient and Family Communication:"][conditional field="Problem2" condition="(Problem2).is('Patient and Family Communication:')"] 
[checkbox name="Problem20" value="Spoke at bedside|Spoke via telephone"] with [select name="variable_1" value="spouse of|mother of|father of|child of|DPOA of"] patient regarding [checkbox name="Problem21" value="current treatment plan|change in condition|results of testing"]. They [checkbox name="Problem22" value="are able to ask questions|verbalize concerns|and state an agreement with the current plan|and request that"] [textarea name="variable_100" default=""].
[comment memo="PCP or Specialist Communication"]
[checkbox name="Problem3" value="Primary Care/Specialist Communication:"][conditional field="Problem3" condition="(Problem3).is('Primary Care/Specialist Communication:')"] Spoke with [select name="variable_200" value="specialist|primary care provider"] [text name="variable_202" default=""][select name="variable_201" value=", MD|, DO|, NP|, PA"] [checkbox name="variable_208" value="with cardiology|with general surgery|with orthopedics|with podiatry|with ID|with neuro|with nephro|with urology|with HIV med clinic|with OBGYN"] regarding patients [checkbox name="variable_204" value="admission|hospital course|disposition|death"]. They [checkbox name="variable_205" value="verbalize understanding and agree with plan|make the following recommendations:"] [textarea name="variable_206" default=""].[/conditional]
[comment memo="Case Management Communication"]
[checkbox name="Problem1" value="Case Management:"][conditional field="Problem1" condition="(Problem1).is('Case Management:')"] 
[checkbox name="Problem400" value="Discussed plan of care with case management."] 
[checkbox name="Problem401" value="Planned discharge to home|Planned discharge to swing bed program|Planned discharge to inpt rehab|Planned discharge to SNF|with home health|with hospice"]. [checkbox name="Problem402" value="Patient and caregiver has been involved in this decision-making and agrees with plan."] 
[checkbox name="Problem403" value="Patient will have DME needs upon discharge. Case management is assisting with this. Needs will include:|wheelchair|walker|cane|orthotic device|home oxygen|home IV antibiotic therapy|Patient will not have any DME needs upon discharge"] 
[checkbox name="Problem404" value="Please see CM notes for additional information."] 
[comment memo="End of Shift Communication"]
[checkbox name="Problem4" value="End of Shift Communication:"][conditional field="Problem4" condition="(Problem4).is('End of Shift Communication:')"] End of shift rounds completed. All questions answered with updated test/diagnostic/consult results provided to patient and/or family. Plan of care discussed. Care transitioned to nocturnist team.[/conditional]
Family Communication

PCP or Specialist Communication

Case Management Communication

End of Shift Communication

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.86, 29 form elements, 1 text boxes, 2 text areas, 15 checkboxes, 3 drop downs, 4 comments, 4 conditionals, 52 total clicks
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