Infectious Disease
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Patient presents for STI exam. Main concerns [text name="variable_1" default=""]

Number of partners over the past year: [text name="variable_44" default=""]

[checkbox name="variable_1" value="heterosexual|homosexual|bisexual"]

[checkbox name="variable_2" value="Penile discharge - None|Penile discharge - Clear|Penile discharge - Yellow"]

[checkbox name="variable_3" value="dysuria -yes|dysuria - no"]
[checkbox name="variable_4" value="Ulcer -yes|Ulcer- no"]
[checkbox name="variable_5" value="Rash - yes|Rash - no"]
[checkbox name="variable_6" value="Fever -yes|Fever - no"]
[checkbox name="variable_222" value="Pelvic Pain - yes|Pelvic Pain -no"]
[checkbox name="variable_7" value="Vaginal discharge|no Vaginal discharge"]
[checkbox name="variable_111" value="Std check in past- yes|Std check in past - no"][text name="variable_555" default=""]
Condom used regularly [checkbox name="variable_100" value="Yes|No"]
[checkbox name="variable_12" value="Currently takes OCP |Pt has IUD|Not on birth control"]
[checkbox name="variable_13" value="Denies concerns about pregnancy|Unsure about pregnancy status|option C"]

[textarea name="variable_12" default=""]
Patient presents for STI exam. Main concerns

Number of partners over the past year:












Condom used regularly



Result - Copy and paste this output: