Infectious Disease
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Patient presents for STI exam.
Number of partners over the past year:[text name="variable_1" default=""]
Heterosexual

Discharge: [checkbox name="variable_1" value="yes|no"]
dysuria: [checkbox name="variable_2" value="yes|no"]
Ulcer: [checkbox name="variable_3" value="yes|no"]
Rash: [checkbox name="variable_4" value="yes|no"]
Fever: [checkbox name="variable_5" value="yes|no"]
Unprotected sex NO

Pelvic Pain: [checkbox name="variable_6" value="yes|no"]
Vaginal discharge: [checkbox name="variable_7" value="yes|no"]
Previous STD [text name="variable_8" default=""]

Std check in past.[checkbox name="variable_1" value="yes|no"]

Partner diagnosed with STD NO.
Multiple partners NO
Condom used regularly [radio name="variable_9" value="yes|inconsistently|"]

Other concerns[textarea name="variable_10" default="sample text"]
Patient presents for STI exam.
Number of partners over the past year:
Heterosexual

Discharge:
dysuria:
Ulcer:
Rash:
Fever:
Unprotected sex NO

Pelvic Pain:
Vaginal discharge:
Previous STD

Std check in past.

Partner diagnosed with STD NO.
Multiple partners NO
Condom used regularly

Other concerns
Result - Copy and paste this output: