F/U HPI
Patient presents to this outpatient follow-up appointment [select value="alone|with guardian|with partner|with case manager|with friend|with family"] for continued evaluation and management of [checkbox value="depression|anxiety|insomnia|inattention|bipolar disorder|mood disorder|mood lability|irritability|agitation|borderline personality disorder|suicidal ideation|schizoaffective disorder|autism spectrum disorder"][text]. Patient was last seen [select value="in this office|in this office by |in another Norther Light outpatient office by |in the inpatient setting due to "] [text] on [date]. Since that time they have [textarea]. [checkbox memo="depression" name="dep" value=""][checkbox memo="anxiety" name="anx" value=""][checkbox memo="adhd" name="adhd" value=""][checkbox memo="sleep" name="sleep" value=""][checkbox memo="mood disorder" name="mood" value=""][conditional field="anxiety" condition="(anxiety).is('')"][/conditional][conditional field="dep" condition="(dep).is('')"]Depression is reported to be [select value="stable|better|somewhat better|somewhat worse|much worse| "][text]. [select value="Current stability is attributed to |Recent improvement is attributed to |Recent exacerbation is attributed to |Lack of improvement is attributed to | "][checkbox value="continuation of current medications|recent medication changes|situational stressors|lifestyle improvements|engaging in individual therapy"][textarea]. Depression is reported to be present [select value="occasionally|almost never|about 50% of the time|most of the time on most days|almost always|"][text]. Depression is rated at [select value="1|2|3|4|5|6|7|8|9|10"]/10 with 10 being the worst. [textarea][/conditional][conditional field="anx" condition="(anx).is('')"] Anxiety is reported to be [select value="stable|better|somewhat better|somewhat worse|much worse| "][text]. [select value="Current stability is attributed to |Recent improvement is attributed to |Recent exacerbation is attributed to |Lack of improvement is attributed to | "][checkbox value="continuation of current medications|recent medication changes|lack of response to medications|situational stressors|lifestyle improvements|engaging in individual therapy"][textarea]. Anxiety is reported to be present [select value="occasionally|mostly around situational stressors|almost never|about 50% of the time|most of the time on most days|almost always|"][text]. Anxiety is rated at [select value="1|2|3|4|5|6|7|8|9|10"]/10 with 10 being the worst. [textarea][/conditional][conditional field="adhd" condition="(adhd).is('')"] ADHD is reported to be [select value="stable|better|somewhat better|somewhat worse|much worse| "][text]. [select value="Current stability is attributed to |Recent improvement is attributed to |Recent exacerbation is attributed to |Lack of improvement is attributed to | "][checkbox value="continuation of current medications|recent medication changes|lack of response to medications|situational stressors|lifestyle improvements|engaging in individual therapy"][textarea]. Inattention is reported to be present [select value="occasionally|mostly around situational stressors|almost never|about 50% of the time|most of the time on most days|almost always|"][text]. [textarea][/conditional][conditional field="sleep" condition="(sleep).is('')"] Sleep is reported to be [select value="stable|better|somewhat better|somewhat worse|much worse| "][text]. [select value="Current stability is attributed to |Recent improvement is attributed to |Recent exacerbation is attributed to |Lack of improvement is attributed to | "][checkbox value="continuation of current medications|recent medication changes|lack of response to medications|situational stressors|lifestyle improvements|engaging in individual therapy"][textarea]. Insomnia is reported to be present [select value="occasionally|mostly around situational stressors|almost never|about 50% of the time|most of the time on most days|almost always|"][text]. [textarea][/conditional][conditional field="mood" condition="(mood).is('')"] Mood disorder is reported to be [select value="stable|better|somewhat better|somewhat worse|much worse| "][text]. [select value="Current stability is attributed to |Recent improvement is attributed to |Recent exacerbation is attributed to |Lack of improvement is attributed to | "][checkbox value="continuation of current medications|recent medication changes|lack of response to medications|situational stressors|lifestyle improvements|engaging in individual therapy"][textarea]. They report [checkbox value="depression|anxiety|irritability|mania|hypomania|impulsivity|emotional lability|"][text] to be present [select value="occasionally|mostly around situational stressors|almost never|about 50% of the time|most of the time on most days|almost always|"][text]. [textarea][/conditional] [select value="They deny wanting medication changes at this time|They are open to considering further medication adjustments for the treatment of |They are requesting medication adjustments for treatment of |"][text]. [textarea]
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Sandbox Metrics: Structured Data Index 0.56, 65 form elements, 23 boilerplate words, 14 text boxes, 12 text areas, 1 dates, 12 checkboxes, 20 drop downs, 6 conditionals, 102 total clicks
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