MOIMSD Care Plan

Current Visit Plan:
[textarea name="variable_12"]
[checkbox memo="URTI"  memo_style="bold-italic" memo_size="small" name="VAC111111" value="Upper Resipratory Infection:"][conditional field="VAC111111" condition="(VAC111111).is('Upper Resipratory Infection:')"] 
[checkbox value="-Suspected common cold based on history and physical exam."]
[checkbox value="-No focal bacterial infection identified."]
[checkbox value="-Advised patient that symptoms duration usually 7-10 days (3 days longer in smokers)."]
[checkbox value="-Reassured patient that antibiotics not currently indicated and have side effects."]
[checkbox value="-Advised patient of the risks/benefits of symptomatic manegment."]
[checkbox value="-Follow up is advised if:
(1)Fever over 38C not relieved by Paracetamol/NSAIDS.
(2)Purulent discharge.
(3)Severe facial pain.
(4)Shortness of breath.
(5)Difficulty swallowing.
(6)Symptoms >10 days.
(7)Symptoms worsen after previously improving."]
[checkbox value="-The patient confirmed understanding and intent to comply."]
[checkbox value="-Pt declined symptomatic treatment."][/conditional]

[checkbox name="variable_21" value="Ordered Investigations:"]
[conditional field="variable_21" condition="(variable_21).is('Ordered Investigations:')"][textarea cols=61 rows=1 name="variable_22"][/conditional]
Care Plan Objectives has been revised and updated on [date name="variable_1"date default="today"] as following:

1- Medical "Measurable Targets"
[checkbox name="variable_2" value="BMI<25|HBA1C<7|BP <140/90|BP <130/80|LDL<100 mg/dl|All health parameters are within normal range|Other"]
[conditional field="variable_2" condition="(variable_2).is('Other')"][textarea cols=61 rows=1 name="variable_13" default=":"][/conditional]
2- Nutritional:
[checkbox name="variable_4" value="Weight loss Diet|Low Salt Diet|Low Fat Diet|Diabetic Diet|Iron Rich Diet|Balanced Diet"] 
[checkbox value="Pregnant Healthy Nutrition" memo="Antenatal" memo_color="purple" memo_style="bold-italic" memo_size="small"]
[checkbox value="Proper Child Nutrition" memo="Well Baby" memo_color="pink" memo_style="bold-italic" memo_size="small"] 
[checkbox value="Geriatric Appropriate Diet" memo="Geriatric" memo_color="midnightblue" memo_style="bold-italic" memo_size="small"]
[checkbox name="variable_17" value="Other"]
[conditional field="variable_17" condition="(variable_17).is('Other')"][textarea cols=61 rows=1 name="variable_18" default=":"][/conditional]
3- Education:
-Patient/Caregiver Competent in :[checklist name="variable_16" value="Reading|Writing"] 
-Education was delivered through: [select value="Direct Communication|Pamphlet|Group therapy|Video"]

-Patient/Caregiver was educated about:
[checkbox name="variable_6" value="Nature of condition, Diagnosis, prognosis and treatment plan|Medications, frequency, side effects & response to therapy|Chronic pain management|Diet & weight control|Physical Activity|Foot care|Smoking hazards|Healthy lifestyle"]
[checkbox memo="Antenatal" memo_color="purple" memo_style="bold-italic" memo_size="small" name="VAC11" value="Pregnant Education:"][conditional field="VAC11" condition="(VAC11).is('Pregnant Education:')"] [checkbox value="Adherence to follow-up visits’ schedule|Breast care and breastfeeding|Danger signs during pregnancy|Personal hygiene|Oral and dental care|Use of medications|Adherence to vaccination schedule|Postpartum follow-up care|Taking care of newborn babies|Abdominal and pelvic-floor exercise"][/conditional]
[checkbox memo="Well Baby" memo_color="pink" memo_style="bold-italic" memo_size="small" name="VAC111" value="Pediatric Education:"][conditional field="VAC111" condition="(VAC111).is('Pediatric Education:')"] [checkbox value="The vaccination schedule of the child|The importance of growth monitoring|Child care|Breastfeeding|Adherence to immunization schedule|Child care post-immunization|Side effects of immunization"][/conditional]
[checkbox memo="Geriatric" memo_color="midnightblue" memo_style="bold-italic" memo_size="small" name="VAC1111" value="Elderly Education:"][conditional field="VAC1111" condition="(VAC1111).is('Elderly Education:')"] [checkbox value="Information about common diseases encountered in elderly|Adherence to follow-up visits|Frequency of taking medication, the side effects, and precautions|Physical activity|Follow-up instructions|Healthy behavior and avoiding harmful habits|Overcoming problems related to memory, vision, hearing, mouth, and teeth problems|Home safety"][/conditional]
[checkbox memo="Communicable" memo_color="orange" memo_style="bold-italic" memo_size="small" name="VAC11111" value="Communicable Disease Education:"][conditional field="VAC11111" condition="(VAC11111).is('Communicable Disease Education:')"] [checkbox value="Information about the disease|Modes of transmission and methods of prevention|Frequency of taking medication, the side effects, and precautions|Healthy behavior|Appropriate food and water handling|Follow-up instructions"][/conditional]
[checkbox name="variable_19" value="Other"]
[conditional field="variable_19" condition="(variable_19).is('Other')"][textarea cols=61 rows=1 name="variable_20" default=":"][/conditional]
-Eduction was provided to the patient/Caregiver who: [select value="acknowledged understanding and intent to follow through with plan|desires second opinion"]

- Need referral to social worker --> [select name="variable_8" value="No|Yes|"]
- Need referral to psychologist --> [select name="variable_9" value="No|Yes|"]

5- Referral to:
[checkbox name="variable_10" value="Ophthalmology Once/Year|Dental clinic Once/Year|Patient does not need referral|Other"]
[conditional field="variable_10" condition="(variable_10).is('Other')"][textarea cols=61 rows=1 name="variable_16" default=":"][/conditional]
6- Follow up: [text size="5"] [select value="|routine f/u visit not indicated|day(s)|week(s)|month(s)"]

7-Patient/Family involvement:
[checklist name="variable_11" value="Patient|Family/Caregiver"]
Current Visit Plan:


Care Plan Objectives has been revised and updated on as following:

1- Medical "Measurable Targets"

2- Nutritional:

Well Baby

3- Education:
-Patient/Caregiver Competent in :
-Education was delivered through:

-Patient/Caregiver was educated about:

Well Baby

-Eduction was provided to the patient/Caregiver who:

- Need referral to social worker -->
- Need referral to psychologist -->

5- Referral to:

6- Follow up:

7-Patient/Family involvement:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.83, 52 form elements, 68 boilerplate words, 1 text boxes, 6 text areas, 1 dates, 27 checkboxes, 2 check lists, 5 drop downs, 10 conditionals, 92 total clicks
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