MHIPU – EP Session

SITUATION

Pt [checkbox name="accepted" value="accepted authors invitation for exercise physiology session|declined authors invitation for exercise physiology session"][conditional field="accepted" condition="(accepted).is('accepted authors invitation for exercise physiology session')"][/conditional]

Location: [checkbox value="Gym|Pts Room|Courtyard|Outside the hospital"]

Exercise pre-screening checklist completed: [select value ="yes|no|NA"]

ExRx: [checkbox value="Nil/NA"]

[checkbox name="BBC" value="Banded bicep curl"][conditional field="BBC" condition="(BBC).is('Banded bicep curl')"] [text default=""][/conditional]
[checkbox name="BCP" value="Banded chest press"][conditional field="BCP" condition="(BCP).is('Banded chest press')"] [text default=""][/conditional]
[checkbox name="BSP" value="Banded shoulder press"][conditional field="BSP" condition="(BSP).is('Banded shoulder press')"] [text default=""][/conditional]
[checkbox name="BTE" value="Banded tricep extension"][conditional field="BTE" condition="(BTE).is('Banded tricep extension')"] [text default=""][/conditional]
[checkbox name="BSLP" value="Banded single leg press"][conditional field="BSLP" condition="(BSLP).is('Banded single leg press')"] [text default=""][/conditional]
[checkbox name="STS1" value="STS"][conditional field="STS1" condition="(STS1).is('STS')"] [text default=""][/conditional]

[text default=""] [checkbox name="SHTR" value="Seated heel to toe raises"][conditional field="SHTR" condition="(SHTR).is('Seated heel to toe raises')"] [text default=""][/conditional]
[text default=""] [checkbox name="BC" value="Bicep curl"][conditional field="BC" condition="(BC).is('Bicep curl')"] [text default=""][/conditional]
[text default=""] [checkbox name="CP" value="Chest press"][conditional field="CP" condition="(CP).is('Chest press')"] [text default=""][/conditional]
[text default=""] [checkbox name="SP" value="Shoulder press"][conditional field="SP" condition="(SP).is('Shoulder press')"] [text default=""][/conditional]
[text default=""] [checkbox name="TE" value="Tricep extension"][conditional field="TE" condition="(TE).is('Tricep extension')"] [text default=""][/conditional]
[text default=""] [checkbox name="CR" value="Calf raises"][conditional field="CR" condition="(CR).is('Calf raises')"] [text default=""][/conditional]
[text default=""] [checkbox name="SQ" value="Squats"][conditional field="SQ" condition="(SQ).is('Squats')"] [text default=""][/conditional]

[checkbox name="CrT" value="Cross trainer"][conditional field="CrT" condition="(CrT).is('Cross trainer')"] [text default=""][/conditional]
[checkbox name="TrM" value="Treadmill"][conditional field="TrM" condition="(TrM).is('Treadmill')"] [text default=""][/conditional]
[checkbox name="RwR" value="Rower"][conditional field="RwR" condition="(RwR).is('Rower')"] [text default=""][/conditional]
[checkbox name="Bk" value="Bike"][conditional field="Bk" condition="(Bk).is('Bike')"] [text default=""][/conditional]

OBSERVATIONS

Level of engagement with author: [select value="positive|unremarkable|poor"]
Movement: [checkbox value="unremarkable|odd / peculiar|slowed|repetitive|restless|agitated|tremorous"]
Attention: [checkbox value="no concerns - attended well|seemed unaware|inattentive|distractible|hyper-vigilant|scattered concentration|preoccupied|confused|focused on irrelevancies"]
Pt looked: [checkbox value="euthymic|tearful|emotional|flat|upset|anxious|angry|sad|irritable|depressed|restless"]
Pt [checkbox value="declined|completed all|completed some of|did not complete"] the exercises offered.

ASSESSMENT

[checkbox name="Unable" value="Unable to rate as Pt declined exercise session"][conditional field="Unable" condition="(Unable).is('Unable to rate as Pt declined exercise session')"]:[text default="no reason given"][/conditional]

[checkbox name="RptRPE" value="Pt report overall RPE:"][conditional field="RptRPE" condition="(RptRPE).is('Pt report overall RPE:')"] [text default="/10"][/conditional]

[checkbox name="Moopre" value="Mood pre-session:"][conditional field="Moopre" condition="(Moopre).is('Mood pre-session:')"] [text default="/10"][/conditional]
[checkbox name="Moodpo" value="Mood post-session:"][conditional field="Moodpo" condition="(Moodpo).is('Mood post-session:')"] [text default="/10"][/conditional]
[checkbox name="Motwa" value="Motivation was:"][conditional field="Motwa" condition="(Motwa).is('Motivation was:')"] [select value="good|fair|low"][/conditional]
[checkbox name="Sesswa" value="Session was:"][conditional field="Sesswa" condition="(Sesswa).is('Session was:')"] [select value="tolerated well|partially tolerated|not tolerated"][/conditional]
[checkbox name="Ptper" value="Pt performed:"][conditional field="Ptper" condition="(Ptper).is('Pt performed:')"] [select value="within limits|below limits"][/conditional]

PLAN

[checkbox value="Encourage pt to participate in physical activity|pt has a copy of the program|copy of program in Pt folder in nurses station|further assessment needed|reassessment needed"]

[textarea default=""]
SITUATION

Pt

Location:

Exercise pre-screening checklist completed:

ExRx:





















OBSERVATIONS

Level of engagement with author:
Movement:
Attention:
Pt looked:
Pt the exercises offered.

ASSESSMENT











PLAN




Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.56, 91 form elements, 24 boilerplate words, 28 text boxes, 1 text areas, 32 checkboxes, 5 drop downs, 25 conditionals, 101 total clicks
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