otitis media correct

Consult completed by 
[select name="variable_1" value="A Video consult|B Phone consult|C In Person"]

Subjective:
[checklist name="variable_1" value="Ear Pain|Ear drainage|Fever|Chills|Headache|Sinus Pain|Other"]

PHYSICAL EXAM:
GENERAL: [checkbox name="variable_1" value="well-developed and well-nourished|alert and cooperative|in no acute distress|well-appearing and nontoxic"], [text name="variable_2" default=""]
HEENT: [checkbox name="variable_3" value="normocephalic|atraumatic|EOMI|vision grossly intact bilaterally|no conjunctival injection or visible discharge|hearing grossly intact bilaterally|no frontal sinus tenderness bilaterally|no maxillary sinus tenderness bilaterally|no oropharyngeal erythema/edema/exudate|no uvular deviation|speaks in clear and unmuffled voice|lips/tongue/dentition/gingiva within normal limits"], [text name="variable_4" default=""]
NECK: [checkbox name="variable_5" value="supple with full range of motion|no stridor|no midline tenderness of stepoff|no cervical lymph node tenderness bilaterally|no cervical lymph node swelling bilaterally|no visible thyromegaly or other masses"], [text name="variable_6" default=""]
RESPIRATORY: [checkbox name="variable_7" value="no audible rales/rhonchi/wheezing|normal respiratory effort|speaking full sentences|no visible signs of tachypnea|no retractions"], [text name="variable_8" default=""]
CARDIOVASCULAR: [checkbox name="variable_9" value="peripheral pulses intact and palpable|pulse felt to be regular rate and rhythm by patient"], [text name="variable_10" default=""]
ABDOMINAL: [checkbox name="variable_11" value="no focal abdominal tenderness elicited upon palpation|no visible abdominal distension|no abnormal masses found upon palpation"], [text name="variable_12" default=""]
BACK: [checkbox name="variable_13" value="no CVAT elicited bilaterally|no midline tenderness or stepoff upon palpation"], [text name="variable_14" default=""]
EXTREMITIES: [checkbox name="variable_15" value="no bony tenderness|no visible gross deformity|no edema|normal range of motion"] of affected area, [text name="variable_16" default=""]
NEUROLOGIC: [checkbox name="variable_17" value="CN III-XII grossly intact|normal-appearing mental status|moving all extremities normally|grossly normal motor strength throughout|sensation to light touch grossly intact throughout|normal speech|normal gait"], [text name="variable_18" default=""]
PSYCH: [checkbox name="variable_19" value="normal-appearing affect"], [text name="variable_20" default=""]





Assessment:
[select value="side|Left|Right|Bilateral"] [select value="diagnosis|otitis media|eustachian tube dysfunction|otalgia- etiology unclear|serous otitis media|myringitis"]
Plan:
Analgesia:  [select value="A/B Otic drops with oral over-the-counter analgesics as needed for pain|A/B Otic drops as needed for pain|Over the counter analgesics as needed for pain"]
Antibiotics:  [select value="none are indicated|Amoxicillin 250 mg twice daily for 5 days|Amoxicillin 500 mg twice daily for 5 days|Amoxicillin 500 mg twice daily for 10 days|Amoxicillin 1 gm twice daily for 10 days|Amoxicillin 125 mg three times daily x 10 days|Amoxicillin 250 mg three times daily x 10 days|Amoxicillin 500 mg three times daily x 10 days|Augmentin 500 mg bid x 10 days|Zithromax 500 mg now then 250 mg qd x 4 days|"]
Follow up:  If not improving or if worsening instructed patient call PCP or another visit in 2-3 days

Education:  [checkbox value="symptomatic measures|medication side effects|natural course"]