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LACERATION REPAIR PROCEDURE NOTE

[checkbox name="woundPE" value="PHYSICAL EXAM:"][conditional field="woundPE" condition="(woundPE).is('PHYSICAL EXAM:')"]
-Wound location - [select name="skinexamlocation1" value="|Scalp|Face|Neck|Shoulder|Chest/Trunk|Abdomen|Buttocks|Inguinal|Male Genital Region|Female Genital Region|Arm|Elbow|Forearm|Wrist|Hand|Finger|Hip|Thigh|Knee|Leg|Ankle|Foot|Toe"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Scalp')"]- [select value="right|left|midline"] [select value="occipital|parietal|temporal|frontal|preauricular|postauricular"] area[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Face')"]- [select value="right|left|midline"] [select value="preauricular|mandibular angle|cheek|nose|periorbital|perioral|chin|submandibular|submental"] area[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Neck')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Shoulder')||(skinexamlocation1).is('Elbow')||(skinexamlocation1).is('Wrist')||(skinexamlocation1).is('Hip')||(skinexamlocation1).is('Knee')||(skinexamlocation1).is('Ankle')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Arm')||(skinexamlocation1).is('Forearm')||(skinexamlocation1).is('Thigh')||(skinexamlocation1).is('Leg')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Chest/Trunk')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Abdomen')"]- [select value="periumbilical|epigastrium|RUQ|LUQ|RLQ|LLQ"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Buttocks')"]- [select value="right|left|midline"] [select value="|medial|lateral"] [select value="perianal|gluteal cleft|cheek|gluteal fold"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Inguinal')"]- [select value="right|left"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Male Genital Region')"]- [select value="right|left|midline"] [select value="penile glans|penile shaft|base of penis|scrotum|periscrotal area"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Female Genital Region')"]- [select value="right|left|midline"] [select value="labia majora|labia minora|perilabial area|periclitoral area|mons pubis|perineum"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Hand')||(skinexamlocation1).is('Finger')"]- [select value="right|left"], [checkbox value="palmar/volar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Finger')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MCP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Foot')||(skinexamlocation1).is('Toe')"]- [select value="right|left"], [checkbox value="plantar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Toe')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MTP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="woundPE" condition="(woundPE).is('PHYSICAL EXAM:')"]
-Wound size/diameter - [text size="8"] [select value="cm|mm"]
-Tissue layers damaged/affected - [checkbox value="epidermis|dermis|subcutaneous layer|muscle/tendon|periosteum/bone"]
-Hemostatic - [select value="|Yes|NO"]
-Wound approximation - [select value="|good|marginal|POOR"]
-Debris/foreign body present - [select value="no|"][text size="20"]

[/conditional]PROCEDURE: LACERATION REPAIR - [comment memo="complexity" memo_size="small"][select name="laccomplexity" value="|simple=12000|intermediate=12030|complex=13100"][conditional field="laccomplexity" condition="(laccomplexity).is('simple=12000')"] - [comment memo="location" memo_size="small"][select name="laclocationsimple" value="scalp/neck/axillae/external genitalia/trunk/extremities=0|face/ear/eyelid/nose/lips/mucous membrane=10"] - [comment memo="size" memo_size="small"][select name="lacsizesimple" value="2.5cm or less=1|2.6-7.5cm=2|7.6-12.5cm=4|12.6-20.0cm=5|20.1-30.0cm=6|30.1cm or greater=7"]
-CPT Code: [calc value="score=(laccomplexity)+(laclocationsimple)+(lacsizesimple)" memo="calc'd value"][/conditional][conditional field="laccomplexity" condition="(laccomplexity).is('intermediate=12030')"] - [comment memo="location" memo_size="small"][select name="laclocationintermediate" value="scalp/axillae/trunk/extremities NOT hands/feet=0|neck/hands/feet/external genitalia=10|face/ears/eyelids/nose/lips/mucous membranes=20"] - [comment memo="size" memo_size="small"][select name="lacsizeintermediate" value="2.5cm or less=1|2.6-7.5cm=2|7.6-12.5cm=4|12.6-20.0cm=5|20.1-30.0cm=6|30.1cm or greater=7"]
-CPT Code: [calc value="score=(laccomplexity)+(laclocationintermediate)+(lacsizeintermediate)" memo="calc'd value"][/conditional][conditional field="laccomplexity" condition="(laccomplexity).is('complex=13100')"] - [comment memo="location" memo_size="small"][select name="laclocationcomplex" value="trunk=0|scalp/arms/legs=20|face/ears/eyelids/nose/lips/mucous membranes=20|forehead/cheeks/chin/mouth/neck/axillae/genitalia/hands/feet=30|eyelids/nose/ears/lips=50"] - [comment memo="size" memo_size="small"][select name="lacsizecomplex" value="2.5cm or less=1|2.6-7.5cm=2|7.6-12.5cm=4|12.6-20.0cm=5|20.1-30.0cm=6|30.1cm or greater=7"]
-CPT Code: [calc value="score=(laccomplexity)+(laclocationcomplex)+(lacsizecomplex)" memo="calc'd value"][/conditional]
ANESTHESIA AGENT(S): [checkbox value="Lidocaine 1% with epinephrine|Lidocaine 1% without epinephrine|Lidocaine 2% with epinephrine|Lidocaine 2% without epinephrine|Marcaine 0.5%|Bicarbonate buffering solution"]
-Total amt used: [text size="5"] ml, [text size="30" default="Lot# "][checkbox memo="Supervising Physician" name="LacRepairSup" value=""][conditional field="LacRepairSup" condition="(LacRepairSup).is('')"]
SUPERVISING PHYSICIAN - Dr. [text size="20"]
[/conditional]
[comment memo="type of consent (choose one)" memo_color="blue"][checkbox memo="verbal" memo_size="small" name="lacrepairconsenttypeverbal" value=""][checkbox memo="written" memo_size="small" name="lacrepairconsenttypewritten" value=""]INDICATIONS/COUNSELING:
-Discussed reason and medical indication(s) for procedure which include(s): [checkbox value="improve hemostasis of wound|improve healing time of wound|prevent excess scarring to ensure optimal return of full function of affected area"]
-Discussed and patient demonstrated understanding of: [checkbox value="limitations and risks of procedure|risk/likelihood of pain during/after procedure|risk/likelihood of bleeding during/after procedure|risk/likelihood of infection after procedure|risk/likelihood of scarring after procedure|complications from anesthesia/analgesia during/after procedure|possibility of repeat procedure needed"]
-Discussed alternatives to procedure which include: leaving wound to heal by secondary intent.
-Patient acknowledged understanding of the above items and desired to proceed.
[conditional field="lacrepairconsenttypeverbal" condition="(lacrepairconsenttypeverbal).is('')"]-Patient consent and timeout were performed verbally in lieu of written consent due to: [checkbox value="austere medical conditions|high patient volume and unavailability of support staff to assist|unavailability of accessible/printed forms"]
-Patient made aware of above conditions preventing written consent and agreed to proceed.
-A time out was performed prior to the procedure ensuring:
[/conditional][conditional field="lacrepairconsenttypewritten" condition="(lacrepairconsenttypewritten).is('')"]-Confirmed that consent form appropriately signed and hardcopy to be scanned into patient's medical record.
-A time out was performed prior to the procedure and documented in a hardcopy form to be scanned into patient's record to include ensuring:
[/conditional][comment memo="only select what's applicable" memo_size="small"][checkbox value="--Patient was identified using full name and DOB.
"][checkbox value="--Patient was evaluated and medical record reviewed including history and lab/imaging findings if applicable.
"][checkbox value="--Procedure and site/side matches the consent form.
"][checkbox value="--Patient was involved in the site/side marking.
"][checkbox name="timeoutlacrepair" value="--For final timeout, physician paused or verbally confirmed with procedure team of:
---correct patient, correct procedure, and correct site/side.
---The patient has been positioned correctly for the procedure.
---All necessary equipment are available.
"][checkbox value="--Instrument sterility verified.
"]
PROCEDURE:
-Wound cleansing was performed in usual fashion with [checkbox value="irrigation with tap water|irrigation with sterile saline|gentle scrub with soapy water|forceps removal of visible debris/foreign body"][checkbox memo="debridement" name="lacrepairdebridement" value=""][conditional field="lacrepairdebridement" condition="(lacrepairdebridement).is('')"]
-Tissue debridement performed. [textarea memo="description" memo_size="small" memo_color="orange"][/conditional]
-Once wound determined sufficiently clean for closure, it was prepared and draped in usual fashion using [select value="|Betadine/Iodine|Chlorhexidine"] per manufacturer and infection control recommendations.
-Anesthetic approach was [select name="lacrepairanesthtechnique" value="local/field block|digital block|regional block"]. [conditional field="lacrepairanesthtechnique" condition="(lacrepairanesthtechnique).is('local/field block')"]The skin overlying the indentified lesion infiltrated with above anesthetic agent.
[/conditional][conditional field="lacrepairanesthtechnique" condition="(lacrepairanesthtechnique).is('digital block')"]Above anesthetic was used to perform block in usual fashion of [select value="R|L"] [select value="1st|2nd|3rd|4th|5th"] [select value="finger|toe"].
[/conditional][conditional field="lacrepairanesthtechnique" condition="(lacrepairanesthtechnique).is('regional block')"][textarea memo="description" memo_size="small" memo_color="orange" rows="2"]
[/conditional][conditional field="laccomplexity" condition="(laccomplexity).is('intermediate=12030')||(laccomplexity).is('complex=13100')"]-Deeper wound closure was required to best reapproximate and prepare the wound for final closure. This was performed subcutaneously [select value="in running fashion|with single horizontal suture"] using [select value="3-0|4-0"] [select value="Vicryl|Monocryl|PDS"] suture material.
[/conditional]-[conditional field="laccomplexity" condition="(laccomplexity).is('intermediate=12030')||(laccomplexity).is('complex=13100')"]Final[/conditional][conditional field="laccomplexity" condition="(laccomplexity).is('simple=12000')"]Wound[/conditional] closure was performed with [text size="3"] simple interrupted sutures using [select value="3-0|4-0|5-0|6-0"] [select value="Ethilon/nylon|Prolene/polypropylene|silk"] suture material.[checkbox memo="freetext comments about suturing" name="lacrepairsuturefreetext" value=""][conditional field="lacrepairsuturefreetext" condition="(lacrepairsuturefreetext).is('')"]
[text default="-" size="80"]
[/conditional][checkbox value="-EBL was less than 1ml and good hemostasis noted.
"][checkbox value="-Antibiotic ointment and a bandage were applied.
"]
PATIENT DISPOSITION
[checkbox value="-Patient tolerated overall procedure well.
"][checkbox value="-No immediate complications noted.
"][checkbox value="-Discussed with patient return precautions to include: fever, erythema, swelling, pain, or purulent discharge from the wound.
"][checkbox value="-Post-procedure care of surgical wound discussed.
"]-Patient instructed to return for suture removal in [text size="5"] days.
-Patient left in stable condition. [textarea memo="optional additional text" memo_size="small"]
LACERATION REPAIR PROCEDURE NOTE

PROCEDURE: LACERATION REPAIR - complexity
ANESTHESIA AGENT(S):
-Total amt used: ml, Supervising Physician
type of consent (choose one) verbal writtenINDICATIONS/COUNSELING:
-Discussed reason and medical indication(s) for procedure which include(s):
-Discussed and patient demonstrated understanding of:
-Discussed alternatives to procedure which include: leaving wound to heal by secondary intent.
-Patient acknowledged understanding of the above items and desired to proceed.
only select what's applicable
PROCEDURE:
-Wound cleansing was performed in usual fashion with debridement
-Once wound determined sufficiently clean for closure, it was prepared and draped in usual fashion using per manufacturer and infection control recommendations.
-Anesthetic approach was . - closure was performed with simple interrupted sutures using suture material. freetext comments about suturing
PATIENT DISPOSITION
-Patient instructed to return for suture removal in days.
-Patient left in stable condition. optional additional text

Result - Copy and paste this output: