GI Bleeding History

Gastrointestinal Bleeding
Onset [text] prior to evaluation
Onset while:  [text]

 A [text] amount of blood was passed via [text]
Now the bleeding has [text] stopped by the time of this evaluation.

The blood contents is the color [text].  

[select value="no|YES"] <-- black or maroon stools
[select value="no|YES"] <-- bright red rectal bleeding
[select value="no|YES"] <-- abdominal pain localized to [text]
[select value="no|YES"] <-- rectal pain
[select value="no|YES"] <-- constipation
[select value="no|YES"] <-- diarrhea
[select value="no|YES"] <-- hematemesis
[select value="no|YES"] <-- nausea/vomiting

[select value="no|YES"] <-- lightheadedness on standing or near-syncope/syncope
[select value="no|YES"] <-- weakness
[select value="no|YES"] <-- fever

[select value="no|YES"] <-- history of peptic ulcer
[select value="no|YES"] <-- history of diverticulitis
[select value="no|YES"] <-- history of Cirrhosis or other portal hypertension
[select value="no|YES"] <-- history of other bleeding sites (genitourinary, epistaxis, hemoptysis)
[select value="no|YES"] <-- history of known bleeding disorder

[select value="no|YES"] <-- Warfarin use
[select value="no|YES"] <-- Aspirin or NSAID use
[select value="no|YES"] <-- Excessive alcohol use

[select value="no|YES"] <-- history of serious CNS risks (e.g. active cancer, immunosuppression, HIV)
[select value="no|YES"] <-- History of rectal trauma (e.g. intercourse)
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
reference: contributed by Dr. Scott Moses, creator/author of the Family Practice Notebook [link url="http://www.fpnotebook.com" memo="website"][/conditional]