Male genitourinary symptoms history
Male genitourinary symptoms history Onset [text] prior to evaluation Onset while: [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]. Pain modifiers Relieved with [text] Worse with [text] Specific Genitourinary Symptoms: [select value="no|YES"] <-- Penile Discharge [text] [select value="no|YES"] <-- Dysuria [select value="no|YES"] <-- Frequency [select value="no|YES"] <-- Hematuria [select value="no|YES"] <-- Hematospermia [select value="no|YES"] <-- Urinary obstruction (last urinated [text]) Associated Symptoms: [select value="no|YES"] <-- decreased appetite (last ate at [text]) [select value="no|YES"] <-- nausea [select value="no|YES"] <-- vomiting [text] [select value="no|YES"] <-- diarrhea [select value="no|YES"] <-- constipation (last stool at [text]) [select value="no|YES"] <-- black or bloody stool [select value="no|YES"] <-- fever Pertinent PMH [select value="no|YES"] <-- STD [select value="no|YES"] <-- Epididymitis [select value="no|YES"] <-- Prostatitis [select value="no|YES"] <-- BPH [select value="no|YES"] <-- Prostate Cancer [select value="no|YES"] <-- Kidney stones [select value="no|YES"] <-- Urinary tract infections [select value="no|YES"] <-- Diverticulitis Pertinent Past Surgeries: [select value="no|YES"] <-- Appendectomy [select value="no|YES"] <-- TURP [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="http://www.fpnotebook.com" memo="website"][/conditional]
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