[textarea name="variable_1" default="Patient that presents today via Telehealth complaining of OS/OS/OU redness and discharge. There is also gritty and itchy eyes with increased tearing."]
[text name="variable_1" default="Symptoms have been present since"]
[date name="variable_1" default="06/26/2020"]
[radio name="variable_1" value=" NO RED FLAGS, there is no moderate top severe eye pain, photophobia, intense redness of the affected area, reduced visual acuity, foreign body, penetrating eye injur| Yes, RED FLAGS present: moderate top severe eye pain, photophobia, intense redness of the affected area, reduced visual acuity, foreign body, penetrating eye injury ---> NEEDS TO GO TO THE ED IMMEDIATELY"]
[checkbox name="variable_1" value=" Needs ER immediately|Needs UC immediately|Follow-up with UC if symptoms have not improved in 10 days"]
[checklist name="variable_1" value="chills|dry cough|Hemoptysis|SOB|headache|nausea or vomiting|nasal congestion or discharge|dizziness|anosmia|Ageusia"]
PHONE/VIDEO EXAM: (vitals to be added into addendum)
GENERAL: Alert, calm, conversant in NAD
ENT: No dysphonia.
LUNGS: Unlabored respirations, speaking in full sentences
NEURO: Normal speech. Alert and oriented.
PSYCHIATRIC: Normal mood. Normal insight and judgement.
[select name="variable_1" value=" Viral: Tearing, foreign body sensation, mucous, semitransparent discharge, with no Preauricular adenopathy. Tarsal conjunctiva has a bumpy appearance. Associated with recent upper respiratory illness. Viral Conjunctivitis is self-limited and treatment is aimed at patients' comfort. Cool compresses are often soothing. Patients are advised to wash their hands frequently. Topical antibiotics are not required, and topical corticosteroids are contraindicated| Allergic: Itching. Watery discharge, + Papillary hypertrophy. History of allergy, atopy and rhinorrhea. Azelastine use 1 drop twice a day for 5 days. Use cool compresses 5 times a day or as needed |HSV and VZV: Associated with pain and/or paresthesia of the nearby skin. Skin lesions or vesicles along eyelid margin or periocular skin. Corneal involvement with possible dendritic lesion. Go to the ER immediately|Bacterial: Mucoid and purulent discharge, with crusting and edema of the conjunctiva (chemosis) and lids, accompanied by burning sensation. Ofloxacin Drops 0.3% 1 drop 2H × 48H; then q2H × 5 days or Erythromycin Ointment 0.5% Apply to affected eye for 7 days "]