PC Clinic

Patient is being seen in the clinc today for [select name="visittype" value="acute illness or injury|medication refills|chronic disease management|annual physical|WCC|sports physical|review of diagnostics"].

[textarea name="cc" default=""]

[select name="Ros" value="Denies any secondary symptoms.|Denies|Endorses"] [checkbox name="rev" value="fever|chills|malaise|chest pain|palpitations|shortness of breath|cough|wheezing|abd pain|nausea|vomiting|diarrhea|constipation|reflux|dysuria|hematuria|vaginal discharge|vaginal itching|vaginal odor|testicular pain|rash|joint pain|arthralgia|extremity weakness|decreased ROM|LE edema|headache|blurry vision|syncope|vertigo|confusion|changes in speech pattern|headache|seizures"]

[select name="Ros" value="Denies any secondary symptoms.|Denies|Endorses"] [checkbox name="rev" value="fever|chills|malaise|chest pain|palpitations|shortness of breath|cough|wheezing|abd pain|nausea|vomiting|diarrhea|constipation|reflux|dysuria|hematuria|vaginal discharge|vaginal itching|vaginal odor|testicular pain|rash|joint pain|arthralgia|extremity weakness|decreased ROM|LE edema|headache|blurry vision|syncope|vertigo|confusion|changes in speech pattern|headache|seizures"]

GEN: [select name="gen" value="Well-groomed, well-appearing, no acute distress.|Well-appearing, non-toxic pediatric patient, developmentally intact.|"]

HEENT: [select name="HEENT" value="Normocephalic, atraumatic.|"]

CHEST: [select name="CHEST" value="Speaking in full sentences. Resps even and unlabored, no symptoms of resp distress or compromise|No nasal flaring, no tachypnea, no retractions or accessory muscle use. No cyanosis.|"]

CV: [select name="CV" value="No peripheral edema.|"]

MS: [select name="MS" value="FROM to all extremities. Able to bear weight and ambulate.|FROM to all limbs.|"]

NEURO: [select name="Neuro" value="Alert and oriented. Speech clear. No overt focal findings present.|Neurologically intact for age.|"]

PSYCH: [select name="Psych" value="Normal mood and affect.|Developmentally intact.|"]


[checkbox name="variable_1" value="I have sent medications to the pharmacy we have on file.|I have ordered additional imaging for you. Once the results return, our office will notify you.|Once lab results are available, we will notify you of results."]

[text name="dc" default=""]

Please make sure to read all of the printed material provided to you at todays visit.Follow Up: Please follow up with us in 

[text name="fu" default=""]

Thank you for allowing us to care for you today. Please remember that you can reach out to us at any time with questions or concerns. Our goal is to make your healthcare experience seamless so please do not hesitate to tell us how we can improve.Remember to call us immediately if you have any concerns about your health, changing or worsening symptoms, or if you have been seen in the emergency room, hospitalized, have seen any other healthcare providers or have had changes in your medication. This allows us to be fully involved in your care and provide the best treatment plan possible.

**If you are having difficulty accessing or affording any medications we prescribe, please let us know right away so we can discuss alternatives. **
Patient is being seen in the clinc today for .







GEN:

HEENT:

CHEST:

CV:

MS:

NEURO:

PSYCH:






Please make sure to read all of the printed material provided to you at todays visit.Follow Up: Please follow up with us in



Thank you for allowing us to care for you today. Please remember that you can reach out to us at any time with questions or concerns. Our goal is to make your healthcare experience seamless so please do not hesitate to tell us how we can improve.Remember to call us immediately if you have any concerns about your health, changing or worsening symptoms, or if you have been seen in the emergency room, hospitalized, have seen any other healthcare providers or have had changes in your medication. This allows us to be fully involved in your care and provide the best treatment plan possible.

**If you are having difficulty accessing or affording any medications we prescribe, please let us know right away so we can discuss alternatives. **

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.81, 16 form elements, 168 boilerplate words, 2 text boxes, 1 text areas, 3 checkboxes, 10 drop downs, 84 total clicks
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