Allergy & Otolaryngology
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[comment memo="HPI"]
Patient presents for evaluation of [text name= default=""] [comment memo="duration"][text name= default=""]. Patient reports history of associated symptoms[checkbox name= value="purulent nasal discharge|congestion over the maxillary sinuses|Congestions over the frontal sinuses||sore throat|non-productive cough|productive cough|nasal congestion||fever|fatigue|headache|abdominal pain|diarrhea|Otalgia|facial pain| ansomia |Dysgeusia |Halitosis| Appetite normal| Appetite decreased| normal wet nappies| decreased wet nappies | SOB|LE edema|syncopy|Hemoptasis|"]
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Patient denies[checkbox name= value="purulent nasal discharge|congestion over the maxillary sinuses|Congestions over the frontal sinuses||sore throat|non-productive cough|productive cough|nasal congestion||fever|fatigue|headache|abdominal pain|diarrhea|Otalgia|facial pain| ansomia |Dysgeusia |Halitosis| Appetite normal| Appetite decreased| normal wet nappies| decreased wet nappies | SOB|LE edema|syncopy|Hemoptasis|"]
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Patient has tried [checkbox value="nothing|acteminophen|ibuprofen|OTC cough medications|DayQuil"] for symptoms. [comment memo="additional notes"][textarea default=""]
[text name="variable_1" default=""]


[checkbox name= value="Denies hx of frequent sinus infections| no recent abx use|"].


[select name= value="|Immunizations Up-to-date|Flu shot this season "]
HPI
Patient presents for evaluation of duration. Patient reports history of associated symptoms
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Patient denies
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Patient has tried for symptoms. additional notes



.


Result - Copy and paste this output: