Viral Infection History

[textarea default="History provided by ***.
The patient has been ill for *** days.
Symptoms have included ***rhinorrhea/headache/myalgias/fever/chills/cough/sore throat/nausea/vomiting/diarrhea***.
Patient has not had ***rhinorrhea/headache/myalgias/fever/chills/cough/sore throat/nausea/vomiting/diarrhea***.
The patient ***has not/has*** had ill contacts."]
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
This is an online version of a template by Stephen P. Merry, MD, MPH, Consultant, Department of Family Medicine, Mayo Clinic, Rochester, Minnesota

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Sandbox Metrics: Structured Data Index 0.5, 3 form elements, 1 text areas, 1 checkboxes, 1 conditionals, 2 total clicks
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