Screening exams order

[checklist name="ItemsOrdered" value="Abdominal ultrasound |Colonoscopy|Cologuard |Hemoglobin A1C |Low-dose CT chest |Referral to gynecology for Pap smear |Mammogram|DEXA |HIV antibody |HCV antibody |PSA|Lipid panel"]

[conditional field="ItemsOrdered" condition="condition to test"] any text to display if condition is true [/conditional]


[select name="BoneDensity" value="77080 — Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)|77081 -  Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)|77085 — Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment"]

[select name="Diagnosis" value="Osteopenia M89.9|Osteoporosis M81.0|Screening for osteoporosis Z13.820|Asymptomatic menopausal state Z78.0|Long term use of systemic steroids Z79.52|Personal history of healed osteoporosis fracture Z87.310|Primary hyperparathyroidism E21.0|Hyperparathyroidism, unspecific E21.3|Asymptomatic postprocedural ovarian failure E89.40|Symptomatic postprocedural ovarian failure E89.41"]

[select name="Mammogram" value="77067 — Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed|Breast ultrasound"]

[conditional field="ItemsOrdered" condition="is('Mammogram')"]Mammogram
Diagnosis: Z12.31 Screening for breast cancer[/conditional]


Z12.31 Breast Cancer screening

Cologuard Dx Z12.11

HIV Z11.4

HCV Z72.89














Z12.31 Breast Cancer screening

Cologuard Dx Z12.11

HIV Z11.4

HCV Z72.89

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 1, 6 form elements, 11 boilerplate words, 1 check lists, 3 drop downs, 2 conditionals, 15 total clicks
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