Infectious Disease
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The patient is being seen for cough x[text] days.
Cough [select value="has not been productive|has been productive"].
Frequency is [select value="infrequent|intermittent|constant"].
Severity is [select value="minimal|moderate|severe"].
Fever [select value="is not present|is present"][text name="variable_1" default=""]
Other characteristics include [checkbox value="Dry to productive|sputum clear|sputum purulent|hemoptysis noted|harsh and barking quality|post-tussive emesis"].
Over the counter medications/remedies that have been tried are [text].
Patient has [select value="no known|known"] sick contacts at home, school, or work.
Other symptoms: [checkbox value="sore throat|nasal congestion|earache|headache|myalgias"].
Other clues: [checkbox value="seasonal allergies|gastroesophageal reflux (GERD)"].
History of pulmonary problems: [checkbox name="pulmhx" value="no respiratory problems|frequent pneumonia|frequent bronchitis|asthma|other"][conditional field="pulmhx" condition="(pulmhx).is('other')"][text size=72 memo="<--describe other"][/conditional].
Tobacco: [checkbox name="tobacco" value="Patient is not a smoker|Patient is a current or former smoker|Patient is exposed to second hand smoke"][conditional field="tobacco" condition="(tobacco).is('Patient is a current or former smoker')"] [text size=72 memo="<--smoking details (optional)"][/conditional].
PE/DVT risk factors [checkbox value=" None"].
Patient denies [checkbox value=" chest pain|dyspnea|lower ext edema|hemoptasis, recent travel"].
The patient is being seen for cough x days.
Cough .
Frequency is .
Severity is .
Fever
Other characteristics include .
Over the counter medications/remedies that have been tried are .
Patient has sick contacts at home, school, or work.
Other symptoms: .
Other clues: .
History of pulmonary problems: .
Tobacco: .
PE/DVT risk factors .
Patient denies .
Result - Copy and paste this output: