Visit: [checkbox value="Telehealth. |Office Visit. |Telephone"] [textarea] CC: [checkbox value="pain |nausea |cancer |seizures |glaucoma |crohn's |PTSD |hepatitis C |HIV |AIDS |muscle spasms |cachexia |agitation of Alzheimer's |ALS"] [text name="variable_1" default="sample text"] Condition Associated: [checkbox value="Cachexia/Wasting syndrome |PTSD |Severe or chronic pain |Severe nausea |Severe or persistent muscle spasm |Seizures"] HPI: Patient presents for [checkbox value="an initial MMJ certification. |a MMJ certification renewal. |a MMJ consultation. "] [textarea] SH: Alcohol: [checkbox value="none |rarely |occasionally |regularly "] [text] Tobacco: [checkbox value="none |cigarettes |pipes |vape |chew/dip "] [text] Work: [checkbox value="none |retired |disabled |full time |part time |student |stay-at-home parent"] [text] General - well developed, well nourished, no apparent distress -HEENT - normocephalic, atraumatic, nares patent, mucous membranes moist -Neck - no gross distention, no visible overt defect-PSYCH - appropriate mood/affect -NEURO - mentation normal/appropriate, no gross/overt cranial nerve deficits -ADDITIONAL EXAM - Speaking in full sentences ROS: Attached Medication and allergies reviewed Assessment: [checkbox value=" Patient Qualify for Medical Cannabis Program FU instructions given |Patient does not qualify"] [text] Plan: Will follow up as needed, answered all questions and fu instructions given. RTC and ED instructions given
There are 15 form elements.
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Sandbox Metrics: Structured Data Index 0.53, 15 form elements, 86 boilerplate words, 5 text boxes, 2 text areas, 8 checkboxes, 51 total clicks
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