Abdominal Pain History

Patient complains of abdominal pain.
Onset [text] prior to evaluation
Onset while:  [text]

Associated Pain (0=none, 10=severe)
Location: [text]
Radiation: [text]
Severity now (0-10): [text]
Severity at worst (0-10): [text]
Duration: [text]
Characterized as: [text].

The pain is relieved with [text]
[select value="no|YES"] <-- worse with standing
[select value="no|YES"] <-- pleuritic pain

Associated Symptoms:
[select value="no|YES"] <-- decreased appetite (last ate at [text])
[select value="no|YES"] <-- nausea
[select value="no|YES"] <-- vomiting  [text]
[select value="no|YES"] <-- diarrhea
[select value="no|YES"] <-- constipation (last stool at [text])
[select value="no|YES"] <-- black or bloody stool
[select value="no|YES"] <-- fever
[select value="no|YES"] <-- Dysuria
[select value="no|YES"] <-- Frequency
[select value="no|YES"] <-- Hematuria

Pertinent PMH
[select value="no|YES"] <-- Gall Bladder or liver disease
[select value="no|YES"] <-- GERD
[select value="no|YES"] <-- Peptic ulcer
[select value="no|YES"] <-- Pancreatitis
[select value="no|YES"] <-- Kidney stones
[select value="no|YES"] <-- Urinary tract infections
[select value="no|YES"] <-- Diverticulitis
[select value="no|YES"] <-- Inflammatory Bowel Disease
[select value="no|YES"] <-- Pelvic Infection
[select value="no|YES"] <-- Vascular disease

Pertinent Past Surgeries:
[select value="no|YES"] <-- Appendectomy
[select value="no|YES"] <-- Cholecystectomy

Pertinent Medications:
[select value="no|YES"] <-- NSAIDs
[select value="no|YES"] <-- Excessive Alcohol 

Pitfalls:
[select value="no|YES"] <-- aortic aneurysm history or risk (age over 60, tobacco history)
[select value="no|YES"] <-- pregnancy risk
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
reference:  contributed by Dr. Scott Moses, creator/author of the [link url="//www.fpnotebook.com" memo="(link)"] Family Practice Notebook [/conditional]