Endo Consult Note

Endocrinology Consult Note
[select name="Visit" value="Telehealth|In Person Visit"]
Date of Service -[date name="variable_3" default="today"]

History of Presenting Illness
[textarea name="HPI1" default=""]

Past Medical History
[textarea name="PMH_1" default=""]

Diabetes mellitus [select value="Type 2|Type 1"], diagnosed in [text default="yyyy"]
Complications
Macrovascular - [checkbox name="macro" value="CVA/Stroke|Cardiovascular disease|Peripheral Vascular disease|Erectile Dysfunction"]
Microvascular - [checkbox name="micro" value="Retinopathy|Nephropathy|Neuropathy"]
In reviewing the history, the patient is followed by a [checkbox name="careteam" value="primary care physician|opthomologist|podiatrist"]
[comment memo="write any specific recommendations/remarks by consultants"]
[textarea name="consultants" default=""]

Allergies
[textarea name="allergies_1" default="No Known Allergies"]

Immunization history
[checkbox name="Vaccinations" value="Patient has received Pneumococcal (PCV-23) after age 65|Patient has received annual influenza vaccine|"][conditional field="Vaccinations" condition="(Vaccinations).is('')"][textarea name="vxtxt" default=""][/conditional]

Past Surgical History
[textarea name="Surgery_text" default="Non contributory"]

Family History
[textarea name="family_text" default=""]

Social History
[textarea name="social1" default=""]

Medication
[textarea name="med_1" default=""]

MONITORING:
The patient performs monitoring of blood glucose [select value="once a day|twice a day|three times a day|four times a day|once a week|twice a week|three times a week|at no specific times|at clinic visits"].

Blood Glucose Values 
Range -[text name="range1" default=""]
Average -[text name="avg1" default=""]
Last HBA1C- [text name="a1c" default=""]

The patient's goals for diabetes control are:
[checkbox name="dmgoals" value="MORNING (FASTING) BLOOD SUGAR LESS THAN 130|BLOOD SUGAR PRIOR TO MEALS OF 80-120|BEDTIME BLOOD SUGAR LESS THAN 120|HEMOGLOBIN A1C LESS THAN 7 WITHOUT SIGNIFICANT SYMPTOMS|HEMOGLOBIN A1C LESS THAN 8|"]
[conditional field="dmgoals" condition="(dmgoals).is('')"][textarea name="dmgoalstxt" default=""][/conditional]

Review of Systems
[comment memo="Default will be negative. Click if positive"]
General
[checklist name="ROS1" value="Sleep Disturbances|Fatigue|Recent Falls|Unable to asses/patient nonverbal"]
[conditional field="ROS1" condition="(ROS1).is('Recent Falls')"]
[textarea name="ROStext1" default=""][/conditional]
Skin
[checklist name="ROS8" value="Rashes|Itching|Change in hair or nails"]
Neurological
[checklist name="ROS2" value="Syncope|Headache|Coordination Changes|Weakness| Numbness|Unable to asses/patient nonverbal"]
HEENT
[checklist name="ROS3" value="Vision Changes|Eye Pain|Nasal Congestion|Nasal Discharge|Hearing Changes|Pain in Ear|Dysphagia|Odynophagia|Unable to asses/patient nonverbal"]
Breast
[checklist name="ROS9" value="Lumps|Pain|Discharge"]
Cardiovascular
[checklist name="ROS4" value="Chest Pain|Palpitations|Unable to asses/patient nonverbal"]
Respiratory
[checklist name="ROS5" value="Dyspnea|Cough|Shortness of Breath|Unable to asses/patient nonverbal"]
Gastrointestinal
[checklist name="ROS6" value="Nausea|Vomiting|Diarrhea|Constipation|Abdominal Pain|Unable to asses/patient nonverbal"]
Genitourinary
[checklist name="ROS7" value="Urinary incontinence|Dysuria|Urgency|Frequency|Unable to asses/patient nonverbal"]
Endocrine
[checklist name="ROS9" value="Abnormal Growth|Apetite changes|Increased thirst|Unable to asses/patient nonverbal|"]
[conditional field="ROS9" condition="(ROS9).is('')"]
[textarea name="ROStext1" default=""][/conditional]
Musculoskeletal
[checklist name="ROS10" value="Back pain|Upper extremity weakness|Lower extremity weakness| Range of motion deficits in upper extremity| Range of motion deficits Lower extremity| Joint pain shoulders| Joint Pain Hips| Joint pain Knees| Joint pain ankles|Unable to asses/patient nonverbal|"][conditional field="ROS10" condition="(ROS10).is('')"]
[textarea name="ROStext1" default=""][/conditional]

Labs
[textarea name="lab_1" default=""]

[conditional field="Visit" condition="(Visit).is('In Person Visit')"]
Physical Exam [comment memo="Please write in Vitals"]
Vital Signs - [textarea name="VS1" default="BP- mmgHg T- °F P- beats/min R- breaths/min"]
General - [textarea name="Pe1" default="No acute distress, Well developed, well-nourished, Afebrile"]
Neurological - [textarea name="Pe2" default="Alert and Oriented, Normal mood and affect, Cranial Nerves II-XII grossly intact"]
HEENT - [textarea name="Pe3" default="Head is normocephalic, atraumatic. Bilateral pupils are equal and reactive to light and accommodating. No scleral icterus, no conjunctival pallor. No neck masses were palpated. No carotid bruit auscultated."]
Pulmonary - [textarea name="Pe4" default="Respiratory effort within normal limits. No visible deformities. Chest rise equal bilaterally. Lungs clear to auscultation bilaterally. No rhales or rhonchi."]
Cardiovascular - [textarea name="Pe5" default="Distal pulses 2+ in all extremities. Adequate perfusion. No peripheral signs of cyanosis. No thrills palpated. No murmur auscultated. Normal S1 S2."]
Gastrointestinal - [textarea name="Pe6" default="Abdomen soft, nontender, nondistended. No guarding or tenderness. Bowel sound auscultated."]
Musculoskeletal - [textarea name="Mskphys" default="No obvious in musculature visualized.  No pain on palpation of musculature.  No restrictions in range of motion on passive manipulation of bilateral shoulder, elbow, wrist, hips and knees. Patient able to actively move all 4 extremities. Muscle tone well developed. Strength 5/5 in all extremities."]
Monofilament testing - [textarea name="monofilament" default=""][/conditional]

Assessment
[textarea name="Ass1" default=""]

Plan
[textarea name="Plan1" default=""]