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]
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