PrEP Patient intake v2

HPI:
[text name="agesex" default=""][select name="sexpartner" value=" MSM|FSM|MSF|MSM, MSF"][select name="medicalhistory" value=" without a significant medical history| with a history of "][text name="historyof" default=""]. No complaints today. No rectal or penile discharge. No symptoms of acute HIV.Denies fever,tired feeling,swollen lymph nodes, swollen tonsils, sore throat,joint and muscle aches,diarrhea, a rash.
________
Sexual risk (if not in screening questionnaire)
Condom use:
Substance use:
Medical history:
Medical problems:
Do yu have kidney disease?
Are you circumcised?
Are you pregnant? Are you on family planning?

Sexually Transmitted Disease History
Have you had any flu-like symptoms in last 4 weeks?
Do you have any rectal, penile, or vaginal discharge, ulcers, or rashes rightnow?
Have you been diagnosed with a syphilis, gonorrhea, chlamydia, or trichonomas (STIs) in the last 12 months?Drug Use History

Sexual Behavior History
Who do you have sex with? Men Women BothOther Risk (use for counseling)
What do you think your chances of becoming infected with HIV are in the next 1 year? ( likely)

How confident are you that YOU can use condoms when YOU want to? (unconfident)
S
______
ROS
Personal hx
For men: # of MALE sex partners in last 3 months. # HIV positive. HOw many times condomless?
         # of FEMALE sex partners in last 3 months.Vaginal? Anal?  # HIV positive. HOw many times condomless? 
         
For women: # of MALE sex partners in last 3 months. # HIV positive. HOw many times condomless?       
Drug use: None|Marijuana|Poppers|Cocaine|meth
Education:
Tobacco use: None|Tobacco use:

EXAM

LABS obtained today:HCV antibody, HIV Ab/p24, Hep B Surface Ab, HBs Ag screening, lipid panel, creatinine, Hep B Core AB, total

Screening
Assessment
This is a [text name="age" default=""] with a risk of [select name="partner" value=" MSM|SDC|IVDU|periconception"] here for a PrEP visit. Continue PrEP.
Sexual risk reduction counseling provided.
Medication adherence counseling provided.
Substance use counseling provided.
Discussion regarding medication side effects provided.
Records will be obtained from [text name="records" default="sample text"]
Labs reviewed today: HIV, Cr, BMP, CMP, RPR, oral GC&CT, rectal GC&CT, urine GC&CT, Hepatitis B surface antigen, Hepatitis C, pregnancy test.Please obtain the following labs at the next visit:HIV, Cr, BMP, CMP, RPR, oral GC&CT, rectal GC&CT, urine GC&CT, Hepatitis B surface antigen, Hepatitis C, pregnancy testRTC (telehealth) [select name="RTC" value="3|6"] months to the AHF Wellness PrEP ProgramLab visit in 3 monthsPlan
(See above)