Nephrology
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[date name="variable_1" default="01/15/2019"]
Reason of Consult:
[textarea name="variable_1" default="What is it the primary team is consulting the Nephrology service?. Is it an acute/chronic, or an unexpected symptom?"]

HPI:
[textarea name="hpi_1" default="The first line of any presentation should include age, ethnicity, gender,marital status, and chief complaint. Example: A 32-year-old married white man complains of lower abdominal pain of 8-hour duration."]

PMHx
* KIDNEY DISEASE HISTORY
- CKD: [select name="ckd_1" value="Stage 1|Stage 2|Stage 3|Stage 4|Stage 5|Unknown"]
- Kidney Transplant: [select name="transplant" value="No|Yes"],[select name="transplant_type" value=" |Cadaveric|Living related|Living unrelated"], year:[text name="year_1" default=""]
- Dialysis: [select name="dialysis" value="Yes|No"]
- [checkbox name="variable_1" value="Polycystic Kidney Disease"]

Reason of Consult:


HPI:


PMHx
* KIDNEY DISEASE HISTORY
- CKD:
- Kidney Transplant: ,, year:
- Dialysis:
-

Result - Copy and paste this output:

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