Inpatient H&P

[comment memo="Inpatient H&P SO Portion" memo_size="small"]
cc: [text size="50"]
HPI: [text name="age" size="3"]yo [select name="AD1" value="active duty|retired|dependent"] [conditional field="AD1" condition="(AD1).isNot('dependent')"][text default="rank" size="6"] [/conditional][select name="gender" value="M|F"] presents [select value="in ED|in clinic|via direct transfer|via direct admit"] for [textarea]

ED Course: [textarea]

PMHx: [textarea]

Home Meds: [checkbox value="see med rec"]
[textarea cols="60" rows="10"]

All: [checkbox value="NKDA"][textarea cols="60" rows="3"]

PSHx: [checkbox value="reviewed|noncontributory"][textarea]

FMHx: [checkbox value="reviewed|noncontributory"][textarea]

Soc: [textarea rows="2"][checkbox value="reviewed|noncontributory"]
-Tobacco- [select name="Tobacco" value="denies/never|previous-|current-"][conditional field="Tobacco" condition="(Tobacco).is('previous-')"][select value="Tobacco|Vape|Chew"] - [text size="7"] [select value="pack(s)/day|can(s)/wk|recharge(s)/pod(s)/wk"] x [text size="4"]yrs, quit [text size="4"]yrs ago, denies current use[/conditional][conditional field="Tobacco" condition="(Tobacco).is('current-')"][select value="Tobacco|Vape|Chew"] - [text size="7"] [select value="pack(s)/day|can(s)/wk|recharge(s)/pod(s)/wk"] x [text size="4"]yrs[/conditional]
-EtOH- [select name="EtOH" value="denies/never|previous-|current-"][conditional field="EtOH" condition="(EtOH).is('current-')"][text size="3"] [select value="cans of beer|glasses of wine|shots of whiskey"] [select value="daily (average)|weekly (average)|on weekends only|rarely on special occasions"] for [text size="4"]yrs[/conditional][conditional field="EtOH" condition="(EtOH).is('previous-')"] quit [text size="4"] years ago, denies current use[/conditional]
-Illicit drugs- [select name="illicitdrugs" value="denies/never|previous-|current-"][conditional field="illicitdrugs" condition="(illicitdrugs).is('previous-')"][text size="50"] x [text size="4"]yrs, quit [text size="4"]yrs ago[/conditional][conditional field="Tobacco" condition="(Tobacco).is('current-')"][text size="50"] x [text size="4"]yrs[/conditional]
-Living situation- [text default="lives with" size="60"]

ROS: [comment memo="Use freetext to explain {+}s if needed" memo_size="small"]
-Constitutional-
[checklist value="fever|chills|malaise|unexplained wt gain/loss"] [text size="60"]
-HEENT- [checklist value="vision changes|hearing changes|smell changes|nose sx|throat sx|neck sx"] [text size="60"]
-Resp- [checklist value="cough|SOB"] [text size="60"]
-CV- [checklist value="chest pain|palpitations"] [text size="60"]
-GI- [checklist value="abd pain|Nausea|Vomiting|diarrhea|constipation"] [text size="60"]
-GU- [checklist value="urinary frequency|urinary urgency|pain with urination"] [text size="60"]
-MSK- [checklist value="new/unusual muscle aches/pains"] [text size="60"]

Code status: [select name="codestatus1" value="Full Code|DNR/DNI|other-"][conditional field="codestatus1" condition="(codestatus1).is('other-')"][text size="50"][/conditional]

PE: [comment memo="Use freetext for pertinent PE abnormals" memo_size="small"]
Vitals- [select name="Vitals" value="reviewed/stable|reviewed/pertinent for- "][conditional field="Vitals" condition="(Vitals).is('reviewed/pertinent for- ')"]BP [text size="5"]/[text size="5"] mmHg, HR [text size="5"]bpm, RR [text size="5"], T [text size="7"]deg F, SpO2 [text size="5"] % on [text default="RA" size="10"][/conditional]
GEN- [text size="60"] [checkbox value="well developed|well nourished|A&Ox4|NAD"]
HEENT- [text size="60"] [checkbox value="Normocephalic|atraumatic|conjunctiva clear|sclerae aninteric|TMs with clearly visible landmarks|nares patent|mucous membranes moist|throat nonerythematous/noninjected|good dentition"]
Neck- [text size="60"] [checkbox value="soft/supple|no JVD|no thyromegaly|no tender/enlarged lymph nodes"]
CHEST- [text size="60"] [checkbox value="Normal rise and fall B/L|No accessory muscle use"]
HEART- [text size="60"] [checkbox value="RRR|normal S1/S2|No M/R/G|No S3/S4 auscultated|no friction rub"]
LUNGS- [text size="60"] [checkbox value="CTAB|BSE b/l|no wheezes|no crackles|no rhonchi"]
ABD- [text size="60"] [checkbox value="soft|nontender|nondistended|no voluntary/involuntary guarding|no peritoneal signs|bowel sounds present in all 4 quadrants"]
SKIN- [text size="60"] [checkbox value="warm|dry|intact|no edema|no erythema|no ecchymosis"]
EXT- [text size="60"] [checkbox value="no gross deformities noted|no cyanosis|no clubbing"]
NEURO- [text size="60"] [checkbox value="mentating well|moves all extremities equally well|CN 2-12 grossly intact b/l|normal sensorium all 4 extremities|no gross motor deficits|Romberg negative|cerebellar testing normal|DTRs 2/4 x4|gait testing without abnormalities"]

EKG- [select name="EKG" value="none|reviewed-"] [conditional field="EKG" condition="(EKG).is('reviewed-')"][checkbox value="normal sinus rhythm|tachycardia|bradycardia|normal axis|left axis deviation|right axis deviation|PR interval normal|QRS complex normal|No relevant ST segment deviation/elevation in contiguous leads|QT interval not prolonged"] [text size="80"][/conditional]

LABS- [select name="Labs" value="nothing to review|reviewed/unremarkable|reviewed/notable for- "][conditional field="Labs" condition="(Labs).is('reviewed/notable for- ')"][textarea][/conditional]

RADS- [select name="Rads" value="nothing to review|reviewed/unremarkable|reviewed/notable for- "][conditional field="Rads" condition="(Rads).is('reviewed/notable for- ')"][textarea][/conditional]

_____________________________________________________________________________
[comment memo="Inpatient H&P AP Portion"]
A/P: [var name="age"] [var name="AD1"] [var name="gender"] admitting to [select value="|MSP ward|ICU"] for [text size="80"]
[checkbox name="APcopyforward" memo="copy forward prev AP" memo_size="small" memo_color="blue" value=""][conditional field="APcopyforward" condition="(APcopyforward).isNot('')"][select memo="choose problem-based or ICU/systems style" name="notetype" value="|Problem-based Plan|Systems-based Plan"][/conditional][conditional field="notetype" condition="(notetype).is('Problem-based Plan')"]
#[text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[select name="Problem1" value="|#"][/conditional][conditional field="Problem1" condition="(Problem1).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="notetype" condition="(notetype).is('Problem-based Plan')"][select name="Problem2" value="|#"][/conditional][conditional field="Problem2" condition="(Problem2).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="notetype" condition="(notetype).is('Problem-based Plan')"][select name="Problem3" value="|#"][/conditional][conditional field="Problem3" condition="(Problem3).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="notetype" condition="(notetype).is('Problem-based Plan')"][select name="Problem4" value="|#"][/conditional][conditional field="Problem4" condition="(Problem4).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="notetype" condition="(notetype).is('Problem-based Plan')"][select name="Problem5" value="|#"][/conditional][conditional field="Problem5" condition="(Problem5).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="notetype" condition="(notetype).is('Problem-based Plan')"][select name="Problem6" value="|#"][/conditional][conditional field="Problem6" condition="(Problem6).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="notetype" condition="(notetype).is('Problem-based Plan')"][select name="Problem7" value="|#"][/conditional][conditional field="Problem7" condition="(Problem7).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="notetype" condition="(notetype).is('Problem-based Plan')"][select name="Problem8" value="|#"][comment memo="Drop-downs for add'l problems"][/conditional][conditional field="Problem8" condition="(Problem8).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="notetype" condition="(notetype).is('Problem-based Plan')"]

Chronic Medical Conditions: [select name="Chronic" value="none|as follows"]
[/conditional][conditional field="Chronic" condition="(Chronic).is('as follows')"]
[select name="CProblem1" value="|#"][/conditional][conditional field="CProblem1" condition="(CProblem1).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Chronic" condition="(Chronic).is('as follows')"][select name="CProblem2" value="|#"][/conditional][conditional field="CProblem2" condition="(CProblem2).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Chronic" condition="(Chronic).is('as follows')"][select name="CProblem3" value="|#"][/conditional][conditional field="CProblem3" condition="(CProblem3).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Chronic" condition="(Chronic).is('as follows')"][select name="CProblem4" value="|#"][/conditional][conditional field="CProblem4" condition="(CProblem4).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Chronic" condition="(Chronic).is('as follows')"][select name="CProblem5" value="|#"][/conditional][conditional field="CProblem5" condition="(CProblem5).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Chronic" condition="(Chronic).is('as follows')"][select name="CProblem6" value="|#"][/conditional][conditional field="CProblem6" condition="(CProblem6).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Chronic" condition="(Chronic).is('as follows')"][select name="CProblem7" value="|#"][/conditional][conditional field="CProblem7" condition="(CProblem7).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Chronic" condition="(Chronic).is('as follows')"][select name="CProblem8" value="|#"][/conditional][conditional field="CProblem8" condition="(CProblem8).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="notetype" condition="(notetype).is('Systems-based Plan')"]
Neuro/Psych/Pain: [select name="NPPplan" value="|no issues, condition to monitor|as follows"][/conditional][conditional field="NPPplan" condition="(NPPplan).is('as follows')"]
[select name="NPP1" value="|#"][/conditional][conditional field="NPP1" condition="(NPP1).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="NPPplan" condition="(NPPplan).is('as follows')"][select name="NPP2" value="|#"][/conditional][conditional field="NPP2" condition="(NPP2).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="NPPplan" condition="(NPPplan).is('as follows')"][select name="NPP3" value="|#"][/conditional][conditional field="NPP3" condition="(NPP3).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="NPPplan" condition="(NPPplan).is('as follows')"][select name="NPP4" value="|#"][/conditional][conditional field="NPP4" condition="(NPP4).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="NPPplan" condition="(NPPplan).is('as follows')"][select memo="drop-downs to each dx" name="NPP5" value="|#"][/conditional][conditional field="NPP5" condition="(NPP5).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="notetype" condition="(notetype).is('Systems-based Plan')"]
Respiratory: [select name="Respplan" value="|no issues, condition to monitor|as follows"][/conditional][conditional field="Respplan" condition="(Respplan).is('as follows')"]
[select name="Resp1" value="|#"][/conditional][conditional field="Resp1" condition="(Resp1).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Respplan" condition="(Respplan).is('as follows')"][select name="Resp2" value="|#"][/conditional][conditional field="Resp2" condition="(Resp2).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Respplan" condition="(Respplan).is('as follows')"][select name="Resp3" value="|#"][/conditional][conditional field="Resp3" condition="(Resp3).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Respplan" condition="(Respplan).is('as follows')"][select name="Resp4" value="|#"][/conditional][conditional field="Resp4" condition="(Resp4).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Respplan" condition="(Respplan).is('as follows')"][select memo="drop-downs for each dx" name="Resp5" value="|#"][/conditional][conditional field="Resp5" condition="(Resp5).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="notetype" condition="(notetype).is('Systems-based Plan')"]
Cardiovascular: [select name="CVplan" value="|no issues, condition to monitor|as follows"][/conditional][conditional field="CVplan" condition="(CVplan).is('as follows')"]
[select name="CV1" value="|#"][/conditional][conditional field="CV1" condition="(CV1).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="CVplan" condition="(CVplan).is('as follows')"][select name="CV2" value="|#"][/conditional][conditional field="CV2" condition="(CV2).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="CVplan" condition="(CVplan).is('as follows')"][select name="CV3" value="|#"][/conditional][conditional field="CV3" condition="(CV3).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="CVplan" condition="(CVplan).is('as follows')"][select name="CV4" value="|#"][/conditional][conditional field="CV4" condition="(CV4).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="CVplan" condition="(CVplan).is('as follows')"][select memo="drop-downs for each dx" name="CV5" value="|#"][/conditional][conditional field="CV5" condition="(CV5).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="notetype" condition="(notetype).is('Systems-based Plan')"]
GI: [select name="GIplan" value="|no issues, condition to monitor|as follows"][/conditional][conditional field="GIplan" condition="(GIplan).is('as follows')"]
[select name="GI1" value="|#"][/conditional][conditional field="GI1" condition="(GI1).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="GIplan" condition="(GIplan).is('as follows')"][select name="GI2" value="|#"][/conditional][conditional field="GI2" condition="(GI2).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="GIplan" condition="(GIplan).is('as follows')"][select name="GI3" value="|#"][/conditional][conditional field="GI3" condition="(GI3).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="GIplan" condition="(GIplan).is('as follows')"][select name="GI4" value="|#"][/conditional][conditional field="GI4" condition="(GI4).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="GIplan" condition="(GIplan).is('as follows')"][select memo="drop-downs for each dx" name="GI5" value="|#"][/conditional][conditional field="GI5" condition="(GI5).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="notetype" condition="(notetype).is('Systems-based Plan')"]
GU: [select name="GUplan" value="|no issues, condition to monitor|as follows"][/conditional] [conditional field="GUplan" condition="(GUplan).is('as follows')"]
[select name="GU1" value="|#"][/conditional][conditional field="GU1" condition="(GU1).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="GUplan" condition="(GUplan).is('as follows')"][select name="GU2" value="|#"][/conditional][conditional field="GU2" condition="(GU2).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="GUplan" condition="(GUplan).is('as follows')"][select name="GU3" value="|#"][/conditional][conditional field="GU3" condition="(GU3).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="GUplan" condition="(GUplan).is('as follows')"][select name="GU4" value="|#"][/conditional][conditional field="GU4" condition="(GU4).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="GUplan" condition="(GUplan).is('as follows')"][select memo="drop-downs for each dx" name="GU5" value="|#"][/conditional][conditional field="GU5" condition="(GU5).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="notetype" condition="(notetype).is('Systems-based Plan')"]
Endo: [select name="Endoplan" value="|no issues, condition to monitor|as follows"][/conditional][conditional field="Endoplan" condition="(Endoplan).is('as follows')"]
[select name="Endo1" value="|#"][/conditional][conditional field="Endo1" condition="(Endo1).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Endoplan" condition="(Endoplan).is('as follows')"][select name="Endo2" value="|#"][/conditional][conditional field="Endo2" condition="(Endo2).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Endoplan" condition="(Endoplan).is('as follows')"][select name="Endo3" value="|#"][/conditional][conditional field="Endo3" condition="(Endo3).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Endoplan" condition="(Endoplan).is('as follows')"][select name="Endo4" value="|#"][/conditional][conditional field="Endo4" condition="(Endo4).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Endoplan" condition="(Endoplan).is('as follows')"][select memo="drop-downs for each dx" name="Endo5" value="|#"][/conditional][conditional field="Endo5" condition="(Endo5).is('#')"][text memo="dx" size="15"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="notetype" condition="(notetype).is('Systems-based Plan')"]
FEN/Renal: [select name="Renalplan" value="|no issues, condition to monitor|as follows"][/conditional][conditional field="Renalplan" condition="(Renalplan).is('as follows')"]
[select name="Renal1" value="|#"][/conditional][conditional field="Renal1" condition="(Renal1).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Renalplan" condition="(Renalplan).is('as follows')"][select name="Renal2" value="|#"][/conditional][conditional field="Renal2" condition="(Renal2).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Renalplan" condition="(Renalplan).is('as follows')"][select name="Renal3" value="|#"][/conditional][conditional field="Renal3" condition="(Renal3).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Renalplan" condition="(Renalplan).is('as follows')"][select name="Renal4" value="|#"][/conditional][conditional field="Renal4" condition="(Renal4).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Renalplan" condition="(Renalplan).is('as follows')"][select memo="drop-downs for each dx" name="Renal5" value="|#"][/conditional][conditional field="Renal5" condition="(Renal5).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="notetype" condition="(notetype).is('Systems-based Plan')"]
Skin: [select name="Skinplan" value="|no issues, condition to monitor|as follows"][/conditional][conditional field="Skinplan" condition="(Skinplan).is('as follows')"]
[select name="Skin1" value="|#"][/conditional][conditional field="Skin1" condition="(Skin1).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Skinplan" condition="(Skinplan).is('as follows')"][select name="Skin2" value="|#"][/conditional][conditional field="Skin2" condition="(Skin2).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Skinplan" condition="(Skinplan).is('as follows')"][select name="Skin3" value="|#"][/conditional][conditional field="Skin3" condition="(Skin3).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Skinplan" condition="(Skinplan).is('as follows')"][select name="Skin4" value="|#"][/conditional][conditional field="Skin4" condition="(Skin4).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Skinplan" condition="(Skinplan).is('as follows')"][select memo="drop-downs for each dx" name="Skin5" value="|#"][/conditional][conditional field="Skin5" condition="(Skin5).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]
[/conditional][conditional field="notetype" condition="(notetype).is('Systems-based Plan')"]
MSK: [select name="MSKplan" value="|no issues, condition to monitor|as follows"][/conditional] [conditional field="MSKplan" condition="(MSKplan).is('as follows')"]
[select name="MSK1" value="|#"][/conditional][conditional field="MSK1" condition="(MSK1).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="MSKplan" condition="(MSKplan).is('as follows')"][select name="MSK2" value="|#"][/conditional][conditional field="MSK2" condition="(MSK2).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="MSKplan" condition="(MSKplan).is('as follows')"][select name="MSK3" value="|#"][/conditional][conditional field="MSK3" condition="(MSK3).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="MSKplan" condition="(MSKplan).is('as follows')"][select name="MSK4" value="|#"][/conditional][conditional field="MSK4" condition="(MSK4).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="MSKplan" condition="(MSKplan).is('as follows')"][select memo="drop-downs for each dx" name="MSK5" value="|#"][/conditional][conditional field="MSK5" condition="(MSK5).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]
[/conditional][conditional field="notetype" condition="(notetype).is('Systems-based Plan')"]
ID: [select name="IDplan" value="|no issues, condition to monitor|as follows"][/conditional] [conditional field="IDplan" condition="(IDplan).is('as follows')"]
[select name="ID1" value="|#"][/conditional][conditional field="ID1" condition="(ID1).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="IDplan" condition="(IDplan).is('as follows')"][select name="ID2" value="|#"][/conditional][conditional field="ID2" condition="(ID2).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="IDplan" condition="(IDplan).is('as follows')"][select name="ID3" value="|#"][/conditional][conditional field="ID3" condition="(ID3).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="IDplan" condition="(IDplan).is('as follows')"][select name="ID4" value="|#"][/conditional][conditional field="ID4" condition="(ID4).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="IDplan" condition="(IDplan).is('as follows')"][select memo="drop-downs for each dx" name="ID5" value="|#"][/conditional][conditional field="ID5" condition="(ID5).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]
[/conditional][conditional field="notetype" condition="(notetype).is('Systems-based Plan')"]
Heme: [select name="Hemeplan" value="|no issues, condition to monitor|as follows"][/conditional] [conditional field="Hemeplan" condition="(Hemeplan).is('as follows')"]
[select name="Heme1" value="|#"][/conditional][conditional field="Heme1" condition="(Heme1).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Hemeplan" condition="(Hemeplan).is('as follows')"][select name="Heme2" value="|#"][/conditional][conditional field="Heme2" condition="(Heme2).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Hemeplan" condition="(Hemeplan).is('as follows')"][select name="Heme3" value="|#"][/conditional][conditional field="Heme3" condition="(Heme3).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Hemeplan" condition="(Hemeplan).is('as follows')"][select name="Heme4" value="|#"][/conditional][conditional field="Heme4" condition="(Heme4).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]

[/conditional][conditional field="Hemeplan" condition="(Hemeplan).is('as follows')"][select memo="drop-downs for each dx" name="Heme5" value="|#"][/conditional][conditional field="Heme5" condition="(Heme5).is('#')"][text memo="dx" size="20"] - [textarea cols="100" rows="6"]
[/conditional][conditional field="notetype" condition="(notetype).is('Systems-based Plan')"]
Lines: [select value="|n/a"] [text memo="peripheral, central, etc" size="80"]
Tubes: [select value="|n/a"] [text memo="NG, OG, ET, Foley, etc" size="80"]
Drains: [select value="|n/a"] [text memo="wound, etc" size="80"]

[/conditional]
[conditional field="APcopyforward" condition="(APcopyforward).isNot('')"]Prophylaxis
-GI: [select value="not indicated|PPI"]
-DVT: [select value="none - low padua score|SCDs|Lovenox|Heparin"]
-Pulm: [checkbox value="incentive spirometer|out of bed to chair|ambulation"]

Dispo: Anticipate hospital stay length of [text size="5"] days. Anticipate discharge home once [comment memo="List discharge criteria"][checkbox value="tolerating PO|dehydration resolved|stable O2 requirement|no O2 requirement|off of IV antibiotics|no longer requiring IV narcotics for pain control|pain adequately resolving"][text size="80"].

Code status: [select value="Full Code|DNR/DNI"]

[/conditional][conditional field="APcopyforward" condition="(APcopyforward).is('')"][textarea rows="30" cols="100"]

[/conditional][textarea memo="signature block" memo_size="small" cols="50" rows="3"]
[comment memo="For use on FMIT Service" memo_size="small"]