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49 responses to “Help”

    • marnold2777 says:

      Thank you Dr. Morgan. This site is a gem I found through AAFP’s FMP Toolkit. I am using it to actively design a residency QI project aimed at standardized team documentation between nurse and provider and reducing EMR/Admin burden. I’ll keep you posted on my progress.

      • Mark Morgan says:

        Thank you! Good luck and let me know if you run into any snags on the site!

    • gwood says:

      Thank you so much Dr Morgan.
      Your site is a marvel, easy to use, and helps to run different tools effectively skipping a cumbersome or impossible merging with EMRs and much more.
      Kind regards,
      George

  2. Jason says:

    This is a great idea and I look forward to using it more but it is difficult to use. It’s difficutlt to find templates that make sense. For example, this anemia evaluation. After selecting micro vs. macrocytosis and the other selections the calculated result should read as an assessment to be able to copy and paste in an EHR. I think this is the idea of the site.
    It should read as follows…based on selections above the calculated result.

    ANEMIA OF CHRONIC DISEASE
    This patient likely has a *microcytic* anemia due to *low* ferritin ….etc etc. without the asterisk of course.
    Peripheral blood smear clues may include rouleaux formation, myelophthisis. CBC clues may include normal RDW.
    Usual causes of ANEMIA OF CHRONIC DISEASE may include Temporal arteritis, Rheumatoid arthritis, Chronic inflammation, or Chronic infection. Unusual causes of ANEMIA OF CHRONIC DISEASE may include Hodgkin lymphoma, Renal cell carcinoma, Castleman disease, or Myelofibrosis.
    *This differential is quite short actually*

    • Mark Morgan MD says:

      Hi – the calculator was an approach to anemia that I thought was interesting. Definitely not the only way to do it. When I’m using these, I usually paste them into the assessment as a type of ‘medical decision making’ section. But I see your point and can try to make another version that addresses your suggestions.

  3. Jason says:

    Is it possible to input data then have the output be put into paragraph form to be used for an EHR assessment? For example, instead of this…

    CURB-65/CRB-65 Score for PneumoniaClinical Features:
    absent <– Confusion
    greater 19 mg per dL (6.8 mmol per L) <– Blood Urea Nitrogen
    less than 30 breaths per minute <– Respiratory rate
    systolic greater than/equal to 90 and diastolic greater than 60 <– Blood pressure
    greater than/equal to 65 CURB-65 = 2: Short inpatient hospitalization or closely-supervised outpatient treatment

    Have the output read…
    In this patient confusion is absent, Blood Urea Nitrogen is greater than 19 mg per dL, the Respiratory rate is less than 30 breaths per minute, the systolic blood pressure is greater than/equal to 90 and diastolic greater than 60, and age is greater than/equal to 65 giving a CURB-65 score of 2. The patient may require short inpatient hospitalization or closely-supervised outpatient treatment.

    • Mark Morgan MD says:

      Hi – it wouldn’t be difficult to make a more plain language output generating version as you’ve suggested. I’ll try to work on that version.

  4. Doc_T says:

    I am able to export document in HTML to run external of site. The note itself will open and run though unable to print using the submit button. I am using Windows 10 OS. Any recommendations? Thank you, Jim

  6. Matt says:

    I just found this website and find a great value in using this for generating very thorough EMS patient care report narratives, but was wondering if there is any way to taylor a note for the EMS community? The Acute Care SOAP V2 is the closest note I found yet it still either lacks or includes information that a paramedic may either include or not assess.

    • Mark Morgan says:

      Sorry for the delay – I need to check the comments more frequently.

      I don’t have bullet proof way of proofreading these notes, but here is my approach:

      If there’s a problem, I take the notes in small chunks and test it at this page: https://www.soapnote.org/generator/

      I went through your note, piece by piece and found these parts had small problems:

      Amnesia After S (Anterograde) Are there any events just AFTER the injury that you/ person has no memory of (even brief)?[checkbox name="variable_1|" value="Yes|No |Unsure|No Duration"]
      Loss of Consciousness: Did the athlete lose consciousness? [checkbox name="variable_1" value="Yes|No |Unsure |No Duration"]

      In this section, there is a variable with the name “variable_1|”. The “|” caused the error there.

      EARLY SIGNS: [checkbox name="variable_1" |Appears dazed or stunned |Is confused about events |Answers questions slowly | Repeats Questions |Forgetful|Value="dizziness|LOC|Balance problems"][checkbox name="Conussion" value="Slow reaction time|amnesia|sleep disturbance"][checkbox name="field_name" value="headaches|irritability|nausea"][checkbox name="field_name" value="vomiting|light sensativity|balance problems"]

      In this section, the first checkbox is missing the ‘value’ part before ‘|Appears dazed….’.

      I changed those two parts and came up with:
      S:
      Date of injury/illness: [date name="variable_1" default="01/05/2019"]
      C/o [textarea name="variable_1" default="sample text"]
      HX of concussion:[checkbox name="variable_1" value="yes |no |unknown"]
      Headache History? [checkbox name="variable_1" value="yes |no |unknown"]

      Developmental History [text name="variable_1" default="sample text"]
      Developmental History [text name="variable_1" default="sample text"]
      O:
      Is there evidence of a forcible blow to the head? [checkbox name="variable_1" value="direct |indirect|Unknown"]

      Is there evidence of intracranial injury or skull fracture? [checkbox name="variable_1" value="Yes|No |Unsure"]

      Location of Impact: [text name="variable_1" default="sample text"]

      Cause: [radio name="variable_1" value=" MVC|Athletics|Assault| Fall"]

      Amnesia Before (Retrograde) Are there any events just BEFORE the injury that you/ person has no memory of (even brief)? [checkbox name="variable_1" value="Yes|No |Unsure"]

      Amnesia After S (Anterograde) Are there any events just AFTER the injury that you/ person has no memory of (even brief)?[checkbox name="variable_1" value="Yes|No |Unsure|No Duration"]
      Loss of Consciousness: Did the athlete lose consciousness? [checkbox name="variable_1" value="Yes|No |Unsure |No Duration"]

      EARLY SIGNS: [checkbox name="variable_1" value="Appears dazed or stunned |Is confused about events |Answers questions slowly | Repeats Questions |Forgetful|dizziness|LOC|Balance problems"][checkbox name="Conussion" value="Slow reaction time|amnesia|sleep disturbance"][checkbox name="field_name" value="headaches|irritability|nausea"][checkbox name="field_name" value="vomiting|light sensativity|balance problems"]

      Seizures: Were seizures observed? [checkbox name="variable_1" value="yes |no |unknown"] Detail [textarea name="variable_1" default="sample text"]

      A:
      [checkbox name="variable_1" value="850.0 (Concussion, with no loss of consciousness) – Positive injury description with evidence of forcible direct/ indirect blow to the head (A1a); plus
      evidence of active symptoms (B) of any type and number related to the trauma (Total Symptom Score >0); no evidence of LOC (A5), skull fracture or
      intracranial injury (A1b).|850.1 (Concussion, with brief loss of consciousness < 1 hour) – Positive injury description with evidence of forcible direct/ indirect blow to the head (A1a); plus evidence of active symptoms (B) of any type and number related to the trauma (Total Symptom Score >0); positive evidence of LOC (A5),
      skull fracture or intracranial injury (A1b|850.9 (Concussion, unspecified) – Positive injury description with evidence of forcible direct/ indirect blow to the head (A1a); plus evidence of active
      symptoms (B) of any type and number related to the trauma (Total Symptom Score >0); unclear/unknown injury details; unclear evidence of LOC (A5), no
      skull fracture or intracranial injury|Other Diagnoses – If the patient presents with a positive injury description and associated symptoms, but additional evidence of intracranial injury (A 1b)
      such as from neuroimaging, a moderate TBI and the diagnostic category of 854 (Intracranial injury) should be considered"]

      p:[textarea name="variable_1" default="sample text"]

      It can be difficult with the long forms because a simple error near the top of the form can wreck the whole thing. But, that’s how I test them. I’d like to make a proofreader in the future – hopefully someday soon!

  8. Bbroyles86 says:

    This is a great tool. The only problem I am having is that I am unable to figure out how to make my form generate the result. I have established my fields and data, but how do I add all the other text I want in the output with all the selections of the user?

      • Bbroyles86 says:

        I figured that one out. Thanks. I put spaces in the variable names, It didn’t like it. LOL:
        Next question: In the top of my sheet, I am gathering all the data, then in the bottom, I generate the info to be copied. Is there a way to mark the lines for info gathering so that they are not included in the result?

  9. kindition says:

    What is the difference between Registry and Scratchpad? When I first tried Registry, if my memory is correct, clicking the “registered” note link from the Registry page returned the specific SOAPnote pre-populated with the input/saved data. Currently it only returns the blank SOAPnote. Did something change, or is Registry just Scratchpad with a dated link to the original blank SOAPnote?

    Great idea and implementation overall, thank you!

  10. Bbroyles86 says:

    [checkbox memo="Radiates" name="co_cp_rad" value=""][conditional field="co_cp_rad" condition="(co_cp_rad).is('')"]
    [checkbox name="co_cp_rads" value="Med Chest|Right Lateral Chest|Left Lateral Chest|Sub-Sternum area|Right shoulder|Left chest|Back - Upper|Back - Lower|Abdomen|Right Arm|Left Arm"]
    [/conditional]

    Can I turn the check box starter in to a yes/no select or radio button?

    • Mark Morgan says:

      to change the check box starter into a yes/no select, it would be [select memo="Radiates" name="co_cp_rad" value="yes|no"] for the first part.

  11. Bbroyles86 says:

    Next Question:
    I am trying to nest questions, which doesn’t seem possible. For Example:
    Does the patient have chest pain? y/n
    if no, skips all those questions.
    if yes: have they had it before? y/n
    If no, skip
    if yes: what happened?

    I was going to nest conditionals, but that doesn’t work. Ideas?

  12. Bbroyles86 says:

    How do I keep the selections at the top from showing up in my result?

    [comment memo="--------------DISPATCH INFO----------------"]
    [select name="dispatched_unit" value="|Unit 21-01|Unit 22-01|Unit 23-01"]

    [comment memo="=========Sending============"]
    [select name="origin_facility_name" value="|Clinton Memorial Hospital (Wilmington)|Highland District Hospital (Hillsboro)|Adena Greenfield Medical Center (Greenfield)|Adena Regional Medical Center (Chillicothe)|Miami Valley Hospital (Dayton)|UC Hospital (Cincinnati)|Bethesda North (Cincinnati)|Other"] [select name="origin_facility_department" value="|Emergency Room|Telemetry Unit|Cardiac Unit|Other"]

    [select name="pre_scheduled" value="|Pre-Scheduled|Non-Scheduled"] [select name="var_001" value="|Non-Emergent|Emergent"]

    [comment memo="=========Receiving============"]
    [select name="destination_facility_name" value="|Clinton Memorial Hospital (Wilmington)|Highland District Hospital (Hillsboro)|Adena Greenfield Medical Center (Greenfield)|Adena Regional Medical Center (Chillicothe)|Miami Valley Hospital (Dayton)|UC Hospital (Cincinnati)|Bethesda North (Cincinnati)|Shriners (Cincinnati)|OSU Wexner Medical Center (Columbus)|Hearth & Care Center (Greenfield)|Edgewood Manor (Greenfield)|Grant Medical Center (Columbus)|Riverside Methodist (Columbus)|Children’s Medical Center (Cincinnati)|Other"] [select name="destination_facility_dept" value="|Telemetry Unit|Cardiac Unit|Acute Care Burn Unit|Emergency department|Intensive Care Unit|Labor and Delivery|Other"]

    [var name="dispatched_unit"] was dispatched to [var name="origin_facility_name"], [var name="origin_facility_department"]. For a [var name=" pre_scheduled "] [var name="var_001"] ALS inter facility transfer of a patient to [var name="destination_facility_name"], [var name="destination_facility_dept"].

    • Mark Morgan says:

      I think what you’re looking for would be a ‘hidden’ parameter for the select boxes you’ve got. I don’t have that currently. I can look into it. The only way to make your example work would be to have the select boxes in the actual text instead of calling the variables and having the select boxes up top.

      • Bbroyles86 says:

        Awesome! Thanks!
        I am running into what appears to be a character limit. It is rather lengthy. I will post it in a few. It is “lab report”, under my name.

      • Bbroyles86 says:

        OK. I can’t save it all together. I had to chunk it into pieces. I am using an excel spreadsheet that generates all the texts for me, it’s pretty slick and helps prevent me from making errors. I have not added the caution notes yet for high values, but it will be super easy in the spreadsheet, then copy paste.

  14. alphabiotic says:

    Hi Mark, I’m having a problem with the “My SOAPnotes” menu, as it does not show my private soapnotes anymore, rather, it just shows a list of all the categories of SOAPnote. Can this be fixed? Kind regards

  15. jagdishrv says:

    Thanks Mark. SOAPnotes is a great tool. Since 2-3 days I am having the following error. When I Log in an click on My Account-> My Soap notes, the system takes me to the categories page instead of my soap notes.

  16. nephrostation says:

    Hi, I can not see my own soap notes in my account to edit.They appear in the general search but not in my list of soapnotes.

    • Mark Morgan says:

      Hi, can you explain what you are seeing? I see there are some that begin with ‘lab report’. Was there one that had all of those ‘lab report’ notes together? That shouldn’t be too much. There isn’t a character limit that I’m aware of.

      • Bbroyles86 says:

        I can run any of the lab report chunks separately just fine. But if I place them together, it fails. A character limit is the only thing that made sense to me.

    • Mark Morgan says:

      That part takes place on the user’s local computer and is basically the browser processing the page’s contents (there’s no signals going backing or forth over the internet to slow it down, it’s all happening on the user’s computer). It might be faster on different computers or browsers, but I’m not really sure.

  19. gwood says:

    Anyone can help Keele STarT Back Screening Tool interpretations. If someone can help. How to make it work? https://www.physio-pedia.com/STarT_Back_Screening_Tool

    Total Score –> [calc value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7)+(Q8)+(Q9)" memo="score"] out of 9 points
    Interpretation –> [calc value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7)+(Q8)+(Q9);score>3?'Medium to High risk':score>0?'Low risk'" memo="interpretation"]

    Sub Score –> [calc value="score1=(Q5)+(Q6)+(Q7)+(Q8)+(Q9)" memo="score1"] out of 5 points
    Interpretation –> [calc value="score1=(Q5)+(Q6)+(Q7)+(Q8)+(Q9);score1>3?'High risk':score1>0?'Medium risk'" memo="interpretation"]

    The Keele STarT Back Screening Tool.
    [select name="Q1" value="Disagree (0 points)=0|Agree (1 points)=1"] <– My back pain has spread down my leg(s) at some time in the last 2 weeks (over the last two weeks)?
    [select name="Q2" value="Disagree (0 points)=0|Agree (1 points)=1"] <– I have had pain in the shoulder or neck at some time in the last 2 weeks (over the last two weeks)?
    [select name="Q3" value="Disagree (0 points)=0|Agree (1 points)=1"] <– I have only walked short distances because of my back pain (over the last two weeks)?
    [select name="Q4" value="Disagree (0 points)=0|Agree (1 points)=1"] <– In the last 2 weeks, I have dressed more slowly than usual because of back pain (over the last two weeks)?
    [select name="Q5" value="Disagree (0 points)=0|Agree (1 points)=1"] <– It’s not really safe for a person with a condition like mine to be physically active (over the last two weeks)?
    [select name="Q6" value="Disagree (0 points)=0|Agree (1 points)=1"] <– Worrying thoughts have been going through my mind a lot of the time (over the last two weeks)?
    [select name="Q7" value="Disagree (0 points)=0|Agree (1 points)=1"] <– I feel that my back pain is terrible and it’s never going to get any better (over the last two weeks)?
    [select name="Q8" value="Disagree (0 points)=0|Agree (1 points)=1"] <– In general I have not enjoyed all the things I used to enjoy (over the last two weeks)?
    [select name="Q9" value="Not at all (0 points)=0|Slightly (0 points)=0|Moderately (0 points)=0|Very much (1 points)=1|Extremely (1 points)=1"] [calc value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7)+(Q8)+(Q9)" memo="score"] out of 9 points
    Interpretation –> [calc value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7)+(Q8)+(Q9);score>3?'Medium to High risk':score>0?'Low risk'" memo="interpretation"]

    Sub Score –> [calc value="score1=(Q5)+(Q6)+(Q7)+(Q8)+(Q9)" memo="score1"] out of 5 points
    Interpretation –> [calc value="score1=(Q5)+(Q6)+(Q7)+(Q8)+(Q9);score1>3?'High risk':score1>0?'Medium risk'" memo="interpretation"]

    • Mark Morgan says:

      First – I set a value for the two different question types and then mapped out the values:
      Questions 1-4 at 1 point each
      Questions 5-9 at 100 points each (I chose 100 points arbitrarily, anything over 10 would probably work)

      Possible combinations and risk values mapped out:
      0… subscore 0, Low Risk
      1… subscore 0, Low Risk
      2… subscore 0, Low Risk
      3… subscore 0, Low Risk
      4… subscore 0, Medium Risk
      100… subscore 1, Low Risk
      101… subscore 1, Low Risk
      102… subscore 1, Low Risk
      103… subscore 1, Medium Risk
      104… subscore 1, Medium Risk
      200… subscore 2, Low Risk
      201… subscore 2, Low Risk
      202… subscore 2, Medium Risk
      203… subscore 2, Medium Risk
      204… subscore 2, Medium Risk
      300… subscore 3, Low Risk (total score less than 4)
      301… subscore 3, Medium Risk
      302… subscore 3, Medium Risk
      303… subscore 3, Medium Risk
      304… subscore 3, Medium Risk
      400… subscore 4, High Risk
      401… subscore 4, High Risk
      402… subscore 4, High Risk
      403… subscore 4, High Risk
      404… subscore 4, High Risk
      500… subscore 5, High Risk
      501… subscore 5, High Risk
      502… subscore 5, High Risk
      503… subscore 5, High Risk
      504… subscore 5, High Risk
      504… subscore 5, High Risk

      • Mark Morgan says:

        The following worked when I tried it out:

        The Keele STarT Back Screening Tool.

        [select name="Q1" value="Disagree (0 points)=0|Agree (1 points)=1"] < – Q1. My back pain has spread down my leg(s) at some time in the last 2 weeks (over the last two weeks)?
        [select name="Q2" value="Disagree (0 points)=0|Agree (1 points)=1"] < – Q2. I have had pain in the shoulder or neck at some time in the last 2 weeks (over the last two weeks)?
        [select name="Q3" value="Disagree (0 points)=0|Agree (1 points)=1"] < – Q3. I have only walked short distances because of my back pain (over the last two weeks)?
        [select name="Q4" value="Disagree (0 points)=0|Agree (1 points)=1"] < – Q4. In the last 2 weeks, I have dressed more slowly than usual because of back pain (over the last two weeks)?
        [select name="Q5" value="Disagree (0 points)=0|Agree (1 points)=1"] < – Q5. It’s not really safe for a person with a condition like mine to be physically active (over the last two weeks)?
        [select name="Q6" value="Disagree (0 points)=0|Agree (1 points)=1"] < – Q6. Worrying thoughts have been going through my mind a lot of the time (over the last two weeks)?
        [select name="Q7" value="Disagree (0 points)=0|Agree (1 points)=1"] < – Q7. I feel that my back pain is terrible and it’s never going to get any better (over the last two weeks)?
        [select name="Q8" value="Disagree (0 points)=0|Agree (1 points)=1"] < – Q8. In general I have not enjoyed all the things I used to enjoy (over the last two weeks)?
        [select name="Q9" value="Not at all (0 points)=0|Slightly (0 points)=0|Moderately (0 points)=0|Very much (1 points)=1|Extremely (1 points)=1"] < - Q9. Overall, how bothersome has your back pain been in the last 2 weeks?

        Total -> [calc value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7)+(Q8)+(Q9)" memo="calculation"] out of 9 points

        Interpretation –> [calc value=”score=(Q1)+(Q2)+(Q3)+(Q4)+((Q5)*100)+((Q6)*100)+((Q7)*100)+((Q8)*100)+((Q9)*100);score>404?’subscore 5, High Risk’:score>304?’subscore 4, High Risk’:score>300?’subscore 3, Medium Risk’:score>204?’subscore 3, Low Risk (total score less than 4)’:score>201?’subscore 2, Medium Risk’:score>104?’subscore 2, Low Risk’:score>102?’subscore 1, Medium Risk’:score>4?’subscore 1, Low Risk’:score>3?’subscore 0, Medium Risk’:’subscore 0, Low Risk'” memo=”categorized by total points and subscore of questions 5 through 9″]

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