Endocrine

[checkbox value="CC:"]
[checkbox value="I feel hot|I feel cold"]
[checkbox value="I feel tired|I feel energetic"]
[checkbox value="I feel hungry|I feel full"]

[checkbox value="HISTORY OF PRESENT ILLNESS"]

[checkbox value="#Hyperthyroidism|#Hypothyroidism"]
[checkbox value="Diagnosed in X"]

[checkbox value="#T2DM|#T1DM|No H/o DM|"]
[checkbox value="Diagnosed in X|"]
[checkbox name="Checkbloodsugar" value="Does not check blood sugars at home. |Checks blood sugars 1-2x per day at home|Checks blood sugars 2-3x per day at home"]

ASSESSMENT/PLAN

[checkbox value="#Diabetes mellitus|#T2DM|#T1DM. "]
[checkbox value="Likely type 1 based on her history.|Likely type 1 based on her history of X.|Likely type 2 based on her history.|Likely type 2 based on her history of X.|"]
[checkbox name="COMPLICATIONS" value="Complicated by|end-stage renal disease|dialysis for (X) years|proliferative retinopathy|peripheral neuropathy|"]
[comment memo="P L A N"]
[checkbox value="-LDL >: repeat Lipid profile atleast every 4months until LDL < X. Last: Due:|-LDL <: check Lipid profile atleast Tri-monthly. Last Done: Next Due|"]
[checkbox value="-Hba1c >7: cont. to recheck atleast every 3 months until <7%. Last: X Due: X|-Hba1c <7: cont. to recheck atleast every year. Last: X Next: X|"]
[checkbox value="-Cr >X:  cont. to recheck atleast every 3 months until kidney function yearly. Last: X Due: X|-Cr <X:  cont. to recheck atleast every 3 months until kidney function yearly. Last: X Due: X|"]
[checkbox value="-Annual Eye exam. Last: X Next: X|"]
[checkbox value="-Annual foot exam. Last: X Next: X|"]
[checkbox value="-microalbuminuria: Recheck urine albumin atleast q1y. Last Done: Next Due"]


+/-ABI indicated














ASSESSMENT/PLAN




P L A N








+/-ABI indicated

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 1, 20 form elements, 4 boilerplate words, 19 checkboxes, 1 comments, 48 total clicks
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