Burn History

Burn Injury
Onset [text] prior to evaluation
Onset while:  [text]
Injury  at [text]

Caused by: [text]
Prior to injury, wound site covered with (e.g. clothing) [text]
After the injury, prior to arrival, wound was treated with [text]

Inhalation injury risks
[select value="no|YES"] <-- smoke inhalation 
[select value="no|YES"] <-- Loss of consciousness
[select value="no|YES"] <-- shortness of breath
[select value="no|YES"] <-- cough productive of soot

Pitfall evaluation:
[select value="no|YES"] <-- wound contamination
[select value="no|YES"] <-- distal numbness
[select value="no|YES"] <-- distal weakness
[select value="no|YES"] <-- distal cold sensation, pallor, or cyanosis
[select value="no|YES"] <-- fever
[select value="no|YES"] <-- wound discharge
[select value="no|YES"] <-- local redness

Pertinent PMH:
Last Tetanus vaccine: [text]
[select value="no|YES"] <-- Diabetes Mellitus
[select value="no|YES"] <-- Peripheral Vascular disease
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
reference: contributed by Dr. Scott Moses, creator/author of the Family Practice Notebook [link url="//www.fpnotebook.com" memo="(link)"][/conditional]