Allergic Rhinitis/Conjunctivits
[date name="variable_1" default="05/08/2020"] Subjective: [select value="less than 1 day|1 day|2 days|3 days|4 days|5 days|6 days|7 days|more than 1 week|more than 1 month"] <-- duration [select value="no|YES"] <-- nasal congestion [select value="no|YES"] <-- nasal discharge [select value="no|YES"] <-- sneezing [select value="no|YES"] <-- watery eyes [select value="no|YES"] <-- cough [select value="no|YES"] <-- headache [select value="no|YES"] <-- fever [select value="no|YES"] <-- past history of similar symptoms Prior treatment [select value="no|YES"] <-- over the counter antihistamines [select value="no|YES"] <-- loratidine [select value="no|YES"] <-- fexofenadine [select value="no|YES"] <-- cetirizine [select value="no|YES"] <-- intranasal steroids Past History [select value="no|YES"] <-- asthma [select value="no|YES"] <-- eczema [textarea] [select name="Q1" value="Allergic Rhinitis|Bronchitis|Conjunctivitis|Dizziness|Gastroenteritis|Migraine/Headache|Otitis|Pharyngitis|Shortness of Breath|Stye|Urinary Tract Infection"][conditional field="Q1" condition="(Q1).is('Allergic Rhinitis')"] [text size=112 default="General Appearance: alert, NAD."] [text size=112 default="Nose: normal, mucosa without edema or inflammation. No clear or purulent nasal discharge."] [text size=112 default="Ears: without pain to external ears, without pain inside ears"] [text size=112 default="Eyes: normal conjunctiva, lids, PERRL"] [text size=112 default="Throat: normal, without erythema, tonsillar inflammation or exudate. No posterior pharyngeal drainage"] [text size=112 default="Lungs: No wheezes or crackles heard in video consult"] [text size=112 default="Heart: no chest pain"] [textarea cols=80 rows=1 default="Assessment: Allergic rhinitis"] Plan: [checkbox value="Fexofenadine 60 mg twice a day|Fexofenadine 180 mg 1 tab daily|Loratidine 10 mg daily|Cetirizine 10 mg 1 tab daily|Over the counter antihistamines|Nasacort 2 sprays each nostril daily|Flonase 2 sprays each nostril daily|Beconase 2 sprays each nostril twice daily|Rhinocort 2 sprays each nostril twice daily|Epinastine instill 1 drop into each eye twice daily"]
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