Star TELE VISIT 11102020 b

STAR TeleVisit:[date default="timestamp"]
[text name="field_name_20" default=""]
Chief complaint: [text name="variable_2" default=""]

History of present illness:
Patient is a [text name="field_name_2" default=""] Year Old [select name="field_name_21" value="Male|Female|MTF|FTM"] with [checkbox name="variable_1828" value="PMH of"] [checkbox name="variable_191" value="HIV|Uncontrolled HIV|HIV virally suppressed|Who Follows For PREP|VL less than 20|VL of"] [text name="variable_432" default=""],[checkbox name="variable_64641" value="CD4 count of"][text name="variable_345611" default=""] As Of [date name="variable_842" default="//2020"],
[checkbox name="variable_76842" value="Medication non compliance|Medication Compliant"][checkbox name="variable_63241" value="Patient takes"][text name="variable_3411" default=""][textarea name="variable_345" default=""][checkbox name="variable_181" value="Patient also states that"][checkbox name="variable_4" value="he|she"] 
[checkbox name="variable_182" value="is also experiencing"] [checkbox name="variable_5" value="field_name" value="headache|fevers|chills|night sweats|light headedness|nausea|dizziness|vomiting|fatigue|cough|sob|dyspenia on exertion|PND|chest pain|palpitations|fainting|loc|weight loss|abdominal pain|dark stool|bloody stool|diarrhea|changes urination|dysuria|hematuria|muscle/joint pain|swelling|numbness|tingling| unusual rashes or lesions."]
[checkbox name="variable_6" value="No headache fevers, chills, night sweats, loss of consciousness, light headedness, nausea, dizziness, vomiting, fatigue, cough, sob, dyspenia on exertion, PND, chest pain, palpitations, fainting, loc, weight loss, abdominal pain, dark stool, bloody stool, diarrhea, changes urination, muscle/joint pain, swelling or unusual rashes or lesions."]
[checkbox name="variable_7" value="No"] [checkbox name="variable_8" value="headache|fevers|chills|night sweats|light headedness|nausea|dizziness|vomiting|fatigue|cough|SOB|loss of consciousness|dyspenia on exertion|PND|chest pain|palpitations|fainting|loc|weight loss|abdominal pain|dark stool|bloody stool|diarrhea|changes urination|muscle/joint pain|numbness|tingling|swelling|or unusual rashes or lesions."]


10 Point Review of Systems: Negative Except above.

PMH/Surgeries/Hospitalizations:[textarea name="variable_82" default="No PMH"]
Meds:[textarea name="variable_12" default="No Medications"]
Allergies:[textarea name="variable_13" default="No Known Drug Allergies"]
Social history:[checkbox name="variable_10" value="Denies toxic habits|History of ETOH abuse|Smokes cigarretes"][text name="variable_14" default=""]
Family history: [textarea name="variable_15" default="Non contributory"]

Physical Exam Deffered

LABS:[checkbox name="variable_25" value="Reviewed"]
[checkbox name="variable_27" value="Significant Labs:"]
[textarea name="variable_49" default=""]
[checkbox name="variable_26" value="CBC: WBCs Hgb Hct Plts
CMP: Na K Cl HCO3 BUN Cr
Ca T Prot Alb AST ALT Alk Phos T Bili
Mg 
Ph
Troponin:
BNP
UA
BC
UC"]
[checkbox name="variable_48" value="pH: CO2:HCO3:PAO2"]
[checkbox name="variable_02307366" value=" Urinanalysis:"][textarea name="variable_3563" default=""]

[checkbox name="variable_08976" value="Microbiology:"][checkbox name="variable_089436" value="Blood Culture:"]
[textarea name="variable_343" default=""]


Radiology:[checkbox name="variable_4012" value="No new images"][textarea name="variable_32" default=""]

Assessment & Plan
[text name="field_name_2" default=""] Year Old [select name="field_name_21" value="Male|Female|MTF|FTM"] with [checkbox name="variable_1828" value="PMH of"] [checkbox name="variable_191" value="HIV|Uncontrolled HIV|HIV virally suppressed|Who Follows For PREP|VL less than 20|VL of"] [text name="variable_432" default=""],[checkbox name="variable_64641" value="CD4 count of"][text name="variable_345611" default=""] As Of [date name="variable_842" default="//2020"],
[checkbox name="variable_76842" value="Medication non compliance|Medication Compliant"][checkbox name="variable_63241" value="Patient takes"][text name="variable_3411" default=""][textarea name="variable_345" default=""]