Upper Extremity Pain/Injury History

Upper Extremity Pain/Injury 
Onset [text] prior to evaluation
Onset while:  [text]
Injury at: [text]

Associated Pain (0=none, 10=severe)
Location: [text]
Radiation: [text]
Severity now (0-10): [text]
Severity at worst (0-10): [text]
Duration: [text]
Characterized as [text].

Relieved with [text]
Worse with [text]

Associated Joint Symptoms
Location: [text]
[select value="no|YES"] <--  Stiffness
[select value="no|YES"] <--  Redness
[select value="no|YES"] <--  Swelling
[select value="no|YES"] <--  Locking or catching
[select value="no|YES"] <--  Giving way or unstable sensation

Dominant hand: [text]

Pitfall evaluation:
[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"] <--  neck pain
[select value="no|YES"] <--  chest pain

Pertinent PMH:
[select value="no|YES"] <--  arthritis history
[select value="no|YES"] <--  prior extremity pain/injury history
[select value="no|YES"] <--  cervical disc history
[select value="no|YES"] <--  heart disease history
[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]