EXAM only

Vital Signs
[checkbox name="vs_bp" memo="BP"][conditional field="vs_bp" condition="(vs_bp).is('')"]BP = [text]/[text] mmHg [/conditional][checkbox name="vs_hr" memo="HR"][conditional field="vs_hr" condition="(vs_hr).is('')"]HR = [text] bpm [/conditional][checkbox name="vs_wt" memo="Recent WT"][conditional field="vs_wt" condition="(vs_wt).is('')"]Recent WT = [text] lbs [/conditional]

Physical Exam
[checkbox name="gen" memo="General appearance"][conditional field="gen" condition="(gen).is('')"]GENERAL APPEARANCE: [checkbox value="no distress|well appearing|well developed|appearing stated age|acutely ill appearing|pale|diaphoretic|chronically ill appearing|overweight or obese|thin|emaciated or cachexic| appearing older than stated age|disheveled|unkempt"][text memo="Other general appearance findings"][/conditional]
[checkbox name="heent" memo="HEENT"][conditional field="heent" condition="(heent).is('')"]HEENT:[checkbox value="normal craniofacial appearance and morphology|sclerae anicteric|no ptosis| normal dentition|poor dentition"][text memo="Other HEENT findings"][/conditional]
[checkbox name="cv" memo="CV"][conditional field="cv" condition="(cv).is('')"]CV: [checkbox value="normal carotid pulses|normal s1, s2|no murmur|normal radial pulses|no ankle swelling"][text memo="Other CV findings"][/conditional]
[checkbox name="resp" memo="RESP"][conditional field="resp" condition="(resp).is('')"]RESPIRATORY: [checkbox value="normal breathing|no cough|no supplemental oxygen use"][text memo="Other respiratory findings"][/conditional]
[checkbox name="msk" memo="MSK"][conditional field="ros_msk" condition="(ros_msk).is('')"]MSK:[checkbox value="joint deformities|hypermobile joints|joint pain with active ROM|joint pain with passive ROM|abnormal limb lengths and/or proportions"][text memo="other MSK findings"][/conditional]
[checkbox name="pe_other" memo="Other PE findings"][conditional field="pe_other" condition="(pe_other).is('')"][textarea][/conditional]
[checkbox name="psych" memo="PSYCH"][conditional field="psych" condition="(psych).is('')"]PSYCH: [checkbox value="calm|cooperative|interacts appropriately|normal rate and volume of speech|normal psychomotor activity|apprehensive or nervous|withdrawn|melancholy|depressed|tearful|aloof|defensive|irritable| angry|full affect|constricted affect|blunted affect|flat affect|labile affect|decreased rate and/or volume of speech|stutter|paucity of speech|decreased prosody of speech|rapid and/or pressured speech|rambling|increased volume of speech|psychomotor slowing|increased psychomotor activity|restlessness|tangential and/or circumstantial responses"][text memo="Other psychiatric findings"][/conditional]

Neurological Exam
[checkbox name="ms" memo="Mental Status"][conditional field="ms" condition="(ms).is('')"]MENTAL STATUS: [checkbox value="alert|lethargic|drowsy|somnolent"][text][/conditional]
[checkbox name="orient" memo="Orientation"][conditional field="orient" condition="(orient).is('')"]ORIENTATION: [checkbox value="normal|intact x3-4| impaired|impaired x 1-2"][text] [/conditional]
[checkbox name="comp" memo="Comprehension"][conditional field="comp" condition="(comp).is('')"]COMPREHENSION: [checkbox value="grossly normal|answers all questions appropriately and follows all directions appropriately|impaired|answers only simple questions appropriately| requires repetition and/or simplification of questions to answer many or most of them appropriately|answers only few or no questions appropriately|follows only simple instructions appropriately|requires visual demonstrations to follow directions appropriately|follows few or no instructions appropriately"][text][/conditional]
[checkbox name="att" memo="Attention/concentration"][conditional field="att" condition="(att).is('')"]ATTENTION/CONCENTRATION: [checkbox value="grossly normal|intact to spelling 'WORLD' backwards|intact to spelling'HOUSE' backwards|normal serial subtractions| intact to naming the months of the year in backwards order|intact to naming the days of the week in backwards order|grossly impaired|difficulty spelling 'WORLD' backwards|difficulty spelling 'HOUSE' backwards|difficulty with serial subtractions|difficulty with naming the months of the year in backwards order|difficulty with naming the days of the week in backwards order"][text][/conditional]
[checkbox name="speech" memo="Speech"][conditional field="speech" condition="(speech).is('')"]SPEECH: [checkbox value="grossly fluent and clear|no word finding pauses or hesitations|speech slightly slurred but readily intelligible|speech moderately slurred but generally intelligible|speech very slurred and barely intelligible|speech fragmentation due to pauses or hesitations"][text][/conditional]
[checkbox name="mem" memo="Memory"][conditional field="mem" condition="(mem).is('')"]MEMORY: [checkbox value="grossly normal recall of recent/remote events|patchy deficits in recall of recent events|grossly impaired recall of recent events|patchy deficits in recall of remote events|grossly impaired recall of remote events|repeating comments or questions during interview|delayed recall 3/3|delayed recall 2/3|delayed recall 1/3|delayed recall 0/3|delayed recall 5/5|delayed recall 4/5|delayed recall 3/5|delayed recall 2/5|delayed recall 1/5| delayed recall 0/5"][text][/conditional]
[checkbox name="lang" memo="Language"][conditional field="lang" condition="(lang).is('')"]LANGUAGE:[checkbox value="grossly normal|naming intact to high and low frequency objects|naming impaired, limited to only high frequency objects|naming grossly impaired|repetition normal| repetition impaired|normal verbal fluency (generation of words from a given category)|impaired verbal fluency (generation of words from a given category)|normal reading|normal writing|impaired reading|impaired writing"][text][/conditional]
[checkbox name="fund" memo="Fund of Knowledge"][conditional field="fund" condition="(fund).is('')"]FUND OF KNOWLEDGE: [checkbox value="grossly normal|intact to current events|intact to current US president|impaired|limited|poor"] [text][/conditional]
[checkbox name="judge" memo="Insight/Judgement"][conditional field="judge" condition="(judge).is('')"]INSIGHT/JUDGEMENT: [checkbox value="grossly normal|adequate/fair|limited|limited| absent/poor"][text][/conditional]
[checkbox name="visuospatial" memo="Visuospatial"][conditional field="visuospatial" condition="(visuospatial).is('')"]VISUOSPATIAL: [checkbox value="grossly normal|normal copy of overlapping shapes|normal copy of a 3D object|normal clock drawing|normal clock drawing outline|normal identification of unique objects in a collage of overlapping shapes|impaired copy of overlapping shapes|impaired copy of a 3D object|difficulty with identification of unique objects in a collage of overlapping shapes"][text][/conditional]
[checkbox name="exec" memo="Executive Function"][conditional field="exec" condition="(exec).is('')"]EXECUTIVE FUNCTION: [checkbox value="grossly normal|no difficulty completing alternating trail|normal number and hand placement on clock drawing|impaired alternating trail|poor planning of number placement on clock drawing|difficulty with hand placement on clock drawing"][text][/conditional]
[checkbox name="reason" memo="Reasoning"][conditional field="reason" condition="(reason).is('')"]REASONING: [checkbox value="grossly normal|normal abstraction of similarities between related word pairs|grossly impaired|impaired abstraction of similarities between related word pairs "][text][/conditional]
[checkbox name="cns" memo="Cranial Nerves"][conditional field="cns" condition="(cns).is('')"]CRANIAL NERVES:[checkbox value="vision grossly normal|visual fields intact to confrontation|peripheral visual fields intact|normal visual tracking|normal conjugate extraocular movements|full range of eye movements|no nystagmus|normal pupillary size, shape, and reactivity|normal facial sensation|normal symmetric facial movements|hearing grossly normal"][text][/conditional]
[checkbox name="motor" memo="Motor"][conditional field="motor" condition="(motor).is('')"]MOTOR:[checkbox value="normal bulk|normal tone|no cogwheel ridigdity|no tremors|no abnormal or involuntary movements|normal symmetric extremity movements|no pronator drift|full 5/5 strength throughout|diffusely decreased muscle bulk|cogwheel rigidity|spasticity|resting hand tremors| +action or intention tremor| postural tremors|involuntary or semi-voluntary facial movements|abnormal posturing of the head/neck|involuntary or semi-voluntary upper extremity movements|involuntary or semi-voluntary lower extremity movements|mild-to-moderate diffuse/generalized weakness|moderate-to-severe diffuse/generalized weakness|mild-to-moderate LUE weakness|mild-to-moderate RUE weakness|moderate-to-severe LUE weakness|moderate-to-severe RUE weakness|mild-to-moderate LLE weakness|mild-to-moderate RLE weakness|moderate-to-severe LLE weakness|moderate-to-severe RLE weakness"][text][/conditional]
[checkbox name="sense" memo="Sensation"][conditional field="sense" condition="(sense).is('')"]SENSATION: [checkbox value="light touch intact and equal throughout|pin prick normal and equal throughout|vibration intact and equal in BL patellae and ankles"][text][/conditional]
[checkbox name="ref" memo="Reflexes"][conditional field="ref" condition="(ref).is('')"]REFLEXES:
RUE (biceps): [select value="absent (0)|hypoactive (1+)|normal (2+)|brisk (3+)|very brisk w/wo clonus (4+)"] 
LUE (biceps): [select value="absent (0)|hypoactive (1+)|normal (2+)|brisk (3+)|very brisk w/wo clonus (4+)"]
RLE (patella):  [select value="absent (0)|hypoactive (1+)|normal (2+)|brisk (3+)|very brisk w/wo clonus (4+)"]
LLE (patella):  [select value="absent (0)|hypoactive (1+)|normal (2+)|brisk (3+)|very brisk w/wo clonus (4+)"] [checkbox value="LLE plantar response downgoing|RLE plantar response downgoing|LLE plantar response equivocal/indeterminate or mute|RLE plantar response equivocal/indeterminate or mute|LLE +Babinski response|RLE +Babinski response|normal postural reflexes|mild-to-moderate impairment of postural reflexes on retropulsion|moderate-to-severe impairment of postural reflexes on retropulsion|LUE +grasp|RUE +grasp|+glabellar/blink reflex"][text][/conditional]
[checkbox name="coor" memo="Coordination"][conditional field="coor" condition="(coor).is('')"]COORDINATION: [checkbox value="grossly normal| normal RH finger tapping|normal LH finger tapping|mild-to-moderate impairment of RH finger tapping|mild-to-moderate impairment of LH finger tapping|moderate-to-severe impairment of RH finger tapping|moderate-to-severe impairment of LH finger tapping|normal alternating hand opening|impaired alternating hand opening|no dysdiadochokinesia with repetitive pronation/supination|no dysdiadochokinesia with RH repetitive pronation/supination|no dysdiadochokinesia with LH repetitive pronation/supination|impaired RH repetitive pronation/supination (+dysdiadochokinesia)|impaired LH repetitive pronation/supination (+dysdiadochokinesia)|normal finger-to-nose (eyes closed)|no RUE dysmetria on finger-to-nose (eyes closed)|no LUE dysmetria on finger-to-nose (eyes closed)|normal finger-nose-finger|no RUE ataxia on finger-nose-finger (eyes open)| no LUE ataxia on finger-nose-finger| dysmetria with RUE on finger-to-nose (eyes closed)|dysmetria with LUE on finger-to-nose (eyes closed)|ataxia with RUE on finger-nose-finger (eyes open)|ataxia with LUE on finger-nose-finger (eyes open)|normal repetitive foot tapping|normal repetitive foot taping with RLE|normal repetitive foot tapping with LLE|mild-to-moderate impairment of RLE foot tapping|mild-to-moderate impairment of LLE foot tapping|moderate-to-severe impairment of RLE foot tapping|moderate-to-severe impairment of LLE foot tapping|normal heel-to-shin|normal RLE heel-to-shin|normal LLE heel-to-shin|ataxia with RLE on heel-to-shin|ataxia with LLE on heel-to-shin"][text][/conditional]
[checkbox name="stance_gait" memo="Stance/Gait"][conditional field="stance_gait" condition="(stance_gait).is('')"]STANCE/GAIT: [checkbox value="no difficulty standing up or getting up from a seated position|normal static stance| normal posture|negative Romberg|normal casual gait|normal stride mechanics|normal arm swing| normal turns|difficulty standing up or getting up from a seated to a standing position|unsteady and/or wide based static stance|wide based gait|veering sideways or staggering during casual gait|abnormal anteroflexed posture|shuffling gait|magnetic gait|antalgic gait|wobbling gait|impaired RUE arme swing|impaired LUE arm swing|activation of RUE tremor while walking|activation of LUE tremor while walking|impaired (multi-step and/or en block) turns|steady casual gait with the use of a cane for support|steady casual gait with the use of a walker for support|wheelchair dependent|bedbound|unable to assess|deferred"][text][/conditional]