Gastroenteritis History

Gastroenteritis
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].

Pain modifiers
Relieved with [text]
Worse with [text]

Key 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 ([text]stools per day)
[select value="no|YES"] <-- black or bloody stool

Exposures
[select value="no|YES"] <-- Bad food intake
[select value="no|YES"] <-- Recent antibiotics
[select value="no|YES"] <-- Recent travel

Associated Symptoms:
[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"] <-- Urinary tract infections
[select value="no|YES"] <-- Diverticulitis
[select value="no|YES"] <-- Inflammatory Bowel Disease
[select value="no|YES"] <-- Diabetes Mellitus

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

Pitfalls:
[select value="no|YES"] <-- pregnancy risk
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
reference:  
[link url="//www.fpnotebook.com" memo="#1"] contributed by Dr. Scott Moses, creator/author of the Family Practice Notebook at fpnotebook.com
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