Endocrine, Nutrition & Obesity
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Constitutional/General:
[select name="" value="c/o of| "] [checkbox name="1" value=" | fatigue|fever|chills|malaise|generalized weakness|diffuse pain|sleeping problems|night sweats|weight changes"]
denies [checkbox name="356" value=" | fatigue|fever|chills|malaise|generalized weakness|diffuse pain|sleeping problems|night sweats|weight changes"]

Head:
[select name="" value="c/o of| "] [checkbox name="2" value=" |headaches|dizziness|syncope|dizziness|sinus pain|LOC"]. Denies [checkbox name="43" value=" |headaches|dizziness|syncope|dizziness|sinus pain|LOC"].

Eyes:
[select name="" value="c/o of| "] [checkbox name="44" value=" |vision loss|blurriness|blind spots|floaters|diplopia|photophobia|eye pain|halos|erythemia|drainage|change in appearance|dryness"]. Denies [checkbox name="4" value=" |vision loss|blurriness|blind spots|floaters|diplopia|photophobia|eye pain|halos|erythemia|drainage|change in appearance|dryness"].

Ears:
[select name="" value="c/o of| "] [checkbox name="5" value=" |ear pain|tinnitus|hearing loss|fullness in ears|drainage|drainage|vertigo|frequent infections"] Denies [checkbox name="6" value=" |ear pain|tinnitus|hearing loss|fullness in ears|drainage|drainage|vertigo|frequent infections"].

Nose,Mouth, and Throat
[select name="" value="c/o of| "] [checkbox name="7" value=" |loss of smell|obstruction|epistaxis|drainage|congestion|tenderness|sinus pain|lesions"] Denies [checkbox name="8" value=" |loss of smell|obstruction|epistaxis|drainage|congestion|tenderness|sinus pain|lesions"].
[select name="" value="c/o of| "] [checkbox name="9" value=" |hoarseness|change in voice B|sore throat|bleeding in mouth|hemoptysis|swollen gums|recent abscess |recent extractions|soreness in mouth|soreness in tongue|ulcers|change in taste"] Denies [checkbox name="10" value=" |hoarseness|change in voice|sore throat|bleeding in mouth|hemoptysis|swollen gums|recent abscess |recent extractions|soreness in mouth|soreness in tongue|ulcers|change in taste"].

Neck:
[select name="" value="c/o of| "] [checkbox name="11" value=" |neck pain|stiffness|edema"] Denies [checkbox name="13" value=" |neck pain|stiffness|edema"]

Cardiac:
[select name="" value="c/o of| "] [checkbox name="15" value=" |chest pain|dyspnea| orthopnea|edema|palpitations|shortness of breath with activities|loss of consciousness|paroxysmal nocturnal dyspnea|need to elevate head at night due to SOB"] . Denies [checkbox name="16" value=" |chest pain|dyspnea| orthopnea|edema|palpitations|shortness of breath with activities|loss of consciousness|paroxysmal nocturnal dyspnea|need to elevate head at night due to SOB"].
[select name="" value="c/o of| "] [checkbox name="17" value=" |claudication|color changes in extremities|parathesias|coldness in extremities|tendency to bruise"] . Denies [checkbox name="18" value=" |claudication|color changes in extremities|parathesias|coldness in extremities"].

Respiratory:
[select name="" value="c/o of| "] [checkbox name="19" value=" |Pain with Respiration|Dyspnea|Cyanosis|Coughing|Wheezing|Sputum|Hemoptysis|Night Sweats|shortness of breath|exercise intolerance with activity"] . Denies [checkbox name="20" value=" |Pain with Respiration|Dyspnea|Cyanosis|Coughing|Wheezing|Sputum|Hemoptysis|Night Sweats|shortness of breath|exercise intolerance with activity"].

Gastrointestinal:
[select name="" value="c/o of| "] [checkbox name="21" value=" |appetite changes|heartburn|dysphagia|abdominal pain|nausea|vomiting|diarrhea|constipation|change in stools|flatulence|anorexia|hematemesis |intolerance to foods|painful bowel movements|bloating|cramping|anorexia|bright red blood per rectum|foul smelling dark black tarry stools|tenesmus"] . Denies[checkbox name="22" value=" |appetite changes|heartburn|dysphagia|abdominal pain|nausea|vomiting|diarrhea|constipation|change in stools|flatulence|anorexia|hematemesis |intolerance to foods|painful bowel movements|bloating|cramping|anorexia|bright red blood per rectum|foul smelling dark black tarry stools|tenesmus"]

Endocrine:
[select name="" value="c/o of| "] [checkbox name="23" value=" |thyroid tenderness|thyroid enlargement|excessive thirst|excessive hunger/excessive urination|heat intolerance|cold intolerance|unexplained Weight changes|changes in face or body hair|striae|increased hat or glove size|mood swings|sweaty|diarrhea|oligomenorrhoea|tremor, palpitations|visual disturbances|feeling slow|feeling tired|depression thin hair| croaky voice|heavy periods|constipation|dry skin|orthostatic symptoms, darkening of skin in non-sun exposed places"] . Denies [checkbox name="24" value=" |thyroid tenderness|thyroid enlargement|excessive thirst|excessive hunger/excessive urination|heat intolerance|cold intolerance|unexplained Weight changes|changes in face or body hair|striae|increased hat or glove size|mood swings|sweaty|diarrhea|oligomenorrhoea|tremor, palpitations|visual disturbances|feeling slow|feeling tired|depression thin hair| croaky voice|heavy periods|constipation|dry skin|orthostatic symptoms, darkening of skin in non-sun exposed places"].

Hematological/Lymphatic:
[select name="" value="c/o of| "] [checkbox name="25" value=" |anemia|purpura|petechia| prolonged or excessive bleeding after dental extraction/injury|bruising|blood clots|enlarged lymph nodes|tender lymph nodes"] . Denies [checkbox name="26" value=" |anemia|purpura|petechia| prolonged or excessive bleeding after dental extraction/injury|bruising|blood clots|enlarged lymph nodes|tender lymph nodes"].

Genitourinary:
[select name="" value="c/o of| "] [checkbox name="27" value=" |dysuria|urinary frequency|urinary urgency| hematuria|flank pain|suprapubic pain|nocturia|polyuria|dark or discolored Urine|hesitancy|terminal dribbling|loss of force of stream|loss or urine with laughing, coughing, sneezing, exercise, position changes|loss of sensation|loss of control"] . Denies [checkbox name="28" value=" |dysuria|urinary frequency|urinary urgency| hematuria|flank pain|suprapubic pain|nocturia|polyuria|dark or discolored Urine|hesitancy|terminal dribbling|loss of force of stream|loss or urine with laughing, coughing, sneezing, exercise, position changes|loss of sensation|loss of control"]

Reproductive (female):
[select name="" value="c/o of| "] [checkbox name="29" value=" |change in cycle duration and frequency|vaginal bleeding irregularities|vaginal discharge|vaginal pain|menstrual pain|changes in sexual arousal or libido|infertility|painful intercourse"] . Denies [checkbox name="30" value=" |change in cycle duration and frequency|vaginal bleeding irregularities|vaginal discharge|vaginal pain|menstrual pain|changes in sexual arousal or libido|infertility|painful intercourse"]. Gravida Para Abortus . LMP: .

Reproductive (male):
[select name="" value="c/o of| "] [checkbox name="31" value=" |difficulty with erection|difficulty with sexual arousal|lack of stamina|difficulty with emissions|testicular pain"] . Denies [checkbox name="32" value=" |difficulty with erection|difficulty with sexual arousal|lack of stamina|difficulty with emissions|testicular pain"].

Musculoskeletal:
[select name="" value="c/o of| "] [checkbox name="33" value=" |joint pain or tenderness|joint swelling|muscles pain|ROM changes|stiffness |bony deformity|misalignment"] . Denies [checkbox name="34" value=" |joint pain or tenderness|joint swelling|muscles pain|ROM changes|stiffness |bony deformity|misalignment"].

Integument:
[select name="" value="c/o of| "] [checkbox name="35" value=" |pruritis|rashes|stria|lesions|wounds|pigmentation changes|acanthosis nigricans|nodules|lumps/bumps|excessive dryness|discoloration|texture changes|eruptions"] . Denies [checkbox name="36" value=" |pruritis|rashes|stria|lesions|wounds|pigmentation changes|acanthosis nigricans|nodules|lumps/bumps|excessive dryness|discoloration|texture changes|eruptions"].

Neurological:
[select name="" value="c/o of| "] [checkbox name="37" value=" |change in sight|changes in smell|change in hearing|changes in taste|change in sensation|faints|fits|funny turns|headache|paraesthesias|numbness|paralysis|limb weakness|poor balance|loss of coordination|speech problems|seizures|dizziness|headaches|tremors|memory loss"] . Denies [checkbox name="38" value=" |change in sight|changes in smell|change in hearing|changes in taste|change in sensation|faints|fits|funny turns|headache|paraesthesias|numbness|paralysis|limb weakness|poor balance|loss of coordination|speech problems|seizures|dizziness|headaches|tremors|memory loss"].

Psychiatric:
[select name="" value="c/o of| "] [checkbox name="39" value=" |depression|change in sleep patterns|anxiety|difficulty concentrating|difficulty paying attention|change in body image|changes in work and school performance|paranoia|anhedonia|lack of energy|episodes of mania|episodic change in personality|sexual or financial binges|irritability|tension|suicidal thoughts|homicidal thoughts"] . Denies [checkbox name="40" value=" |depression|change in sleep patterns|anxiety|difficulty concentrating|difficulty paying attention|change in body image|changes in work and school performance|paranoia|anhedonia|lack of energy|episodes of mania|episodic change in personality|sexual or financial binges|irritability|tension|suicidal thoughts|homicidal thoughts"]

Breasts:
[select name="" value="c/o of| "] [checkbox name="41" value=" |breast pain/soreness|discharge|lumps"]
. Denies [checkbox name="42" value=" |breast pain/soreness|discharge|lumps"]

Vital signs: T[text name="55" default="sample text"] P[text name="56" default="sample text"] R[text name="57" default="sample text"] BP[text name="58" default="sample text"] O2 Sat [text name="59" default="sample text"] on [text name="60" default="sample text"]

Nurtition: Weight: [text name="61" default="sample text"] BMI: [text name="62" default="sample text"] Weight changes: [text name="99" default="sample text"]


LABS

[textarea name="343435" default="sample text"]


Diagnosis:
[text name="633637" default="sample text"]

DDx:
[textarea name="837447" default="sample text"]
==============================================
PLAN:

[textarea name="8333" default="sample text"]
Constitutional/General:

denies

Head:
. Denies .

Eyes:
. Denies .

Ears:
Denies .

Nose,Mouth, and Throat
Denies .
Denies .

Neck:
Denies

Cardiac:
. Denies .
. Denies .

Respiratory:
. Denies .

Gastrointestinal:
. Denies

Endocrine:
. Denies .

Hematological/Lymphatic:
. Denies .

Genitourinary:
. Denies

Reproductive (female):
. Denies . Gravida Para Abortus . LMP: .

Reproductive (male):
. Denies .

Musculoskeletal:
. Denies .

Integument:
. Denies .

Neurological:
. Denies .

Psychiatric:
. Denies

Breasts:

. Denies

Vital signs: T P R BP O2 Sat on

Nurtition: Weight: BMI: Weight changes:


LABS




Diagnosis:


DDx:

==============================================
PLAN:

Result - Copy and paste this output: