Fall Or Syncopal Episode History

Neurology, Subjective/History Elements
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Fall or Syncopal Episode
Onset [text] prior to evaluation
Onset while: [text]

Episode location: [text]
Episode description: [text].

Last similar episode: [text]

[select value="no|YES"] <-- remembers the episode
[select value="no|YES"] <-- remembers after the episode

Episode was preceded by the following symptoms that lasted [text]:
[select value="no|YES"] <-- lightheadedness
[select value="no|YES"] <-- palpitations
[select value="no|YES"] <-- chest pain
[select value="no|YES"] <-- nausea or vomiting
[select value="no|YES"] <-- headache
[select value="no|YES"] <-- abodominal pain
[select value="no|YES"] <-- visual changes

Episode was witnessed by [text] and they reported:
[select value="no|YES"] <-- complete loss of consciousness for a duration of [text]
[select value="no|YES"] <-- Seizure activity
[select value="no|YES"] <-- Confusion following the episode
[select value="no|YES"] <-- associated incontinence of urine or stool
[select value="no|YES"] <-- associated apnea
[select value="no|YES"] <-- associated pulselessness
[select value="no|YES"] <-- associated low blood sugar
[select value="no|YES"] <-- extremity weakness

PMH:
[select value="no|YES"] <-- Recent trauma
[select value="no|YES"] <-- Seizure history
[select value="no|YES"] <-- Diabetes Mellitus history
[select value="no|YES"] <-- Coronary Artery Disease history
[select value="no|YES"] <-- Cerebrovascular Accident history
[select value="no|YES"] <-- Gastrointestinal bleeding history
[select value="no|YES"] <-- Infection history or symptoms (e.g. UTI or pneumonia)
[select value="no|YES"] <-- Other (e.g. pregnancy in women of child bearing age)

Associated Injuries: [text]
[html]<hr>[/html][checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"][html]
reference: contributed by Dr. Scott Moses, creator/author of the <a href="http://www.fpnotebook.com">Family Practice Notebook</a>.[/html][/conditional]
Fall or Syncopal Episode
Onset prior to evaluation
Onset while:

Episode location:
Episode description: .

Last similar episode:

<-- remembers the episode
<-- remembers after the episode

Episode was preceded by the following symptoms that lasted :
<-- lightheadedness
<-- palpitations
<-- chest pain
<-- nausea or vomiting
<-- headache
<-- abodominal pain
<-- visual changes

Episode was witnessed by and they reported:
<-- complete loss of consciousness for a duration of
<-- Seizure activity
<-- Confusion following the episode
<-- associated incontinence of urine or stool
<-- associated apnea
<-- associated pulselessness
<-- associated low blood sugar
<-- extremity weakness

PMH:
<-- Recent trauma
<-- Seizure history
<-- Diabetes Mellitus history
<-- Coronary Artery Disease history
<-- Cerebrovascular Accident history
<-- Gastrointestinal bleeding history
<-- Infection history or symptoms (e.g. UTI or pneumonia)
<-- Other (e.g. pregnancy in women of child bearing age)

Associated Injuries:

display/hide references
Result - Copy and paste this output:

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