General & Administrative
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DISPATCH:[textarea name="dispatch" default=" "]

ARRIVED:[textarea name="arrived" default=" "]

CC:[text name="CC" default=" "]

HPI:[textarea name="hpi" default=" "]

PMHx:[text name="pmhx" default=" "]

ALLERGIES:[checkbox name="allergies_check" value="NKDA"][text name="allergies" default=" "]


ROS:

-Constitutional: [checkbox name="ros_constitutional_check" value="no fever|no chills|no night sweats|no fatigue|no changes in weight"][text name="ros_constitutional" default=" "]
-HEENT: [checkbox name="ros_heent_check" value="no vision changes|No ear pain|no nasal congestion|no sore throat|no cough"][text name="ros_heent" default=" "]
-Cardiovascular: [checkbox name="ros_cardio_check" value="No chest pain|no palpitations|no swelling of extremities"][text name="ros_cardio" default=" "]
-Respiratory:[checkbox name="ros_resp_check" value="No SOB|no hemoptysis|no dyspnea"][text name="ros_resp" default=" "]
-GI: [checkbox name="ros_gi_check" value="No change in appetite|no abdominal pain|no hematemasis|no hematochezia|no N/V/D|Nausea|Vomiting|Diarrhea"][text name="ros_gi" default=" "]
-GU: [checkbox name="ros_gu_check" value="no urinary frequency|no urinary urgency|no dysuria|no hematuria|no leakage of urine"][text name="ros_gu" default=" "]
-MSK: [checkbox name="ros_msk_check" value="no back pain|no joint pain|no muscle aches"][text name="ros_msk" default=" "]
-Skin: [checkbox name="ros_skin_check" value="no rash|no bruising|no lesions"][text name="ros_skin" default=" "]
-Neuro: [checkbox name="ros_neuro_check" value="no headache|no dizziness|no syncope"][text name="ros_neuro" default=" "]
-Psych: [checkbox name="ros_psych_check" value="denies SI/HI|No hallucination|No depression|no anxiety"][text name="ros_psych" default=" "]
-Endocrine: [checkbox name="ros_endo_check" value="no heat/cold intolerance|no excessive thirst|no polyuria"][text name="ros_endo" default=" "]
-Hematologic: [checkbox name="ros_heme_check" value="no excessive bruising|no excessive bleeding|no painless lymph node enlargement"][text name="ros_heme" default=" "]

PHYSICAL EXAM:

-Vitals:[text name="pe_vitals" default=" "]
-General: [checkbox name="pe_general_check" value="WDWN|Well appearing|in no acute distress|overweight|obese"][text name="pe_general" default=" "]
-HEENT: [checkbox name="pe_heent_check" value="normocephalic|atraumatic|PERRLA|white sclera|conjuntica pink|ears patent|no bleeding|bleeding|positive HALO test|negative HALO test|dry mucous membranes|extra salivatory |normal mucous|normal pharynx"][text name="pe_heent" default=" "]
-Cardiovascular: [checkbox name="pe_cardio_check" value="normal RRR|no carotid bruits|no edema|peripheral pulses intact|no cyanosis|capillary refill < 2 seconds|atraumatic"][text name="pe_cardio" default=" "]
-Respiratory: [checkbox name="pe_resp_check" value="CTA bilaterally|no rales, rhonchi, wheezes|no retractions|no accessory muscles being used|wheezing|upper respiratory congestion"][text name="pe_resp" default=" "]
-GI:[checkbox name="pe_gi_check" value="atrumatic|BS present in all 4 quadrants|abdomen soft/nontender to palpation|nondistended|No rigidity|no guarding|no masses"][text name="pe_gi" default=" "]
-MSK: [checkbox name="pe_msk_check" value="normal ROM|no pain on palpation|strength 5/5 in all extremities"][text name="pe_msk" default=" "]
-Skin: [checkbox name="pe_skin_check" value="no rash|no lesion|no discoloration"][text name="pe_skin" default=" "]
-Neuro: [checkbox name="pe_neuro_check" value="Grossly oriented X 4|gait WNL|sensation intact|normal reflexes"][text name="pe_neuro" default=" "]
-Psych: [checkbox name="pe_psych_check" value="Pleasant, calm and cooperative|Judgement and insight intact|thought process normal|normal affect"][text name="pe_psych" default=" "]
-Hematologic: [checkbox name="pe_heme_check" value="cervical lymphadenopathy|no lymphadenopathy|no tenderness or masses palpated|no bruises"][text name="pe_heme" default=" "]

TREATMENT:[textarea name="Rx" default=" "]

TRANSPORT: [checkbox name="pe_trans_check" value="Secured to stretcher|3 straps|5 straps|loaded for transport|Emergency|Non Emergency|Emergency Downgraded to Non Emergency|Non Emergency Upgraded to Emergency"][text name="pe_trans" default=" "]

REPORT: [checkbox name="pe_rep_check" value="Verbal report to nurse|belongings left with nurse|improvement in patient condition|decline in patient condition"][text name="pe_rep" default=" "]

REPORT WRITER:[text name="RW" default=" "]
DISPATCH:

ARRIVED:

CC:

HPI:

PMHx:

ALLERGIES:


ROS:

-Constitutional:
-HEENT:
-Cardiovascular:
-Respiratory:
-GI:
-GU:
-MSK:
-Skin:
-Neuro:
-Psych:
-Endocrine:
-Hematologic:

PHYSICAL EXAM:

-Vitals:
-General:
-HEENT:
-Cardiovascular:
-Respiratory:
-GI:
-MSK:
-Skin:
-Neuro:
-Psych:
-Hematologic:

TREATMENT:

TRANSPORT:

REPORT:

REPORT WRITER:
Result - Copy and paste this output: