Objective/Exam Elements
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PHYSICAL EXAM
[checkbox name="examchaperone" memo="Chaperone" value=""][conditional field="examchaperone" condition="(examchaperone).is('')"]-Chaperone - [select name="examchap1" value="declined by patient|Shaheda Fields|Adriana Avalos|Tenia Wilson|Stephanie Field|Kirsten Huggins|Seleta McCoy|Crissy Lombardo|Jennifer Colon|Sharon Bryant|Sherri Sharpe|Diane McCray|Alberto Botello|Kimberly Bracey|Mariah Doss|Monique Noriega|"][/conditional][conditional field="examchap1" condition="(examchap1).is('')"][text size="60"][/conditional][conditional field="examchaperone" condition="(examchaperone).is('')"]
[/conditional][checkbox name="vitals" memo="Vitals" value=""][conditional field="vitals" condition="(vitals).is('')"]-Vitals - [select name="vitals1" value="reviewed, no remarkable abnormalities|significant for"][text size="50"]
[/conditional][checkbox name="briefexam" memo="Brief Visual Exam" value=""][conditional field="briefexam" condition="(briefexam).is('')"]-General - [text default="well developed, well nourished, no apparent distress" size="80"]
-HEENT - [text default="normocephalic, atraumatic, nares patent, mucous membranes moist" size="80"]
-Neck - [text default="no thyromegaly" size="80"]
-Abd - [text default="non-distended" size="80"]
-Ext - [text default="no cyanosis" size="80"]
-Neuro - [text default="appropriate balance, normal gait" size="80"]
-Psych - [text default="appropriate mood/affect" size="80"]
[/conditional][checkbox name="detailedexam" memo="Detailed Exam" value=""][conditional field="detailedexam" condition="(detailedexam).is('')"][checkbox name="gendetailexam" memo="*" value="-General"][/conditional][conditional field="gendetailexam" condition="(gendetailexam).is('-General')"] --[checkbox name="examgen" value="well developed|well nourished|A&Ox4|NAD"][checkbox name="examgenabn" memo="abnormals" memo_size="small" memo_color="red" value=""][/conditional][conditional field="examgenabn" condition="(examgenabn).is('')"]
--[checkbox value="MILDLY ILL|SLEEPY|APPEARS CONFUSED|APPEARS LETHARGIC|CACHECTIC APPEARANCE|APPEARS OLDER THAN STATED AGE"]
[/conditional][conditional field="gendetailexam" condition="(gendetailexam).is('-General')"][checkbox name="examgenfreetext" memo="free text" memo_color="orange" memo_size="small" value=""][/conditional][conditional field="examgenfreetext" condition="(examgenfreetext).is('')"]--[textarea rows="2" cols="100"]
[/conditional][conditional field="gendetailexam" condition="(gendetailexam).is('-General')"]
[/conditional][conditional field="detailedexam" condition="(detailedexam).is('')"][checkbox name="heentdetailexam" memo="*" value="-HEENT"][/conditional][conditional field="heentdetailexam" condition="(heentdetailexam).is('-HEENT')"] --[checkbox name="examheent" value="normocephalic|atraumatic|conjunctiva clear|sclerae aninteric|TMs with clearly visible landmarks|nares patent b/l|turbinates nonedematous/nonerythematous b/l|mucous membranes moist|throat nonerythematous/noninjected|good dentition"][checkbox name="examheentabn" memo="abnormals" memo_color="red" memo_size="small" value=""][/conditional][conditional field="examheentabn" condition="(examheentabn).is('')"]
[checkbox value="--R CONJUNCTIVAL ERYTHEMA
"][checkbox value="--L CONJUNCTIVAL ERYTHEMA
"][checkbox value="--R TM OPAQUENESS & LOSS OF LANDMARKS
"][checkbox value="--R TM VIEW OBSCURRED BY CERUMEN
"][checkbox value="--L TM OPAQUENESS & LOSS OF LANDMARKS
"][checkbox value="--L TM VIEW OBSCURRED BY CERUMEN
"][checkbox value="--NASAL SEPTUM DEVIATION
"][checkbox value="--TURBINATE EDEMA
"][checkbox value="--TURBINATE ERYTHEMA
"][checkbox value="--NASAL DISCHARGE
"][checkbox value="--TONSILS INJECTED/EDEMATOUS
"][checkbox value="--TONSILS WITH EXUDATE
"][/conditional][conditional field="heentdetailexam" condition="(heentdetailexam).is('-HEENT')"][checkbox name="examheentfreetext" memo="free text" memo_color="orange" memo_size="small" value=""][/conditional][conditional field="examheentfreetext" condition="(examheentfreetext).is('')"]--[textarea rows="2" cols="100"][/conditional][conditional field="heentdetailexam" condition="(heentdetailexam).is('-HEENT')"]
[/conditional][conditional field="detailedexam" condition="(detailedexam).is('')"][checkbox name="neckdetailexam" memo="*" value="-Neck"][/conditional][conditional field="neckdetailexam" condition="(neckdetailexam).is('-Neck')"] --[checkbox name="examneck" value="soft/supple|no JVD|no thyromegaly|no tender/enlarged lymph nodes"][checkbox name="examneckabn" memo="abnormals" memo_color="red" memo_size="small" value=""][/conditional][conditional field="examneckabn" condition="(examneckabn).is('')"]
[checkbox value="--R ANTERIOR CHAIN LYMPHADENOPATHY
"[[checkbox value="--L ANTERIOR CHAIN LYMPHADENOPATHY
"][checkbox value="--R POSTERIOR CHAIN LYMPHADENOPATHY
"][checkbox value="--L POSTERIOR CHAIN LYMPHADENOPATHY
"][checkbox value="JUGULAR VENOUS DISTENSION
"][checkbox value="GOITER"]
[/conditional][conditional field="neckdetailexam" condition="(neckdetailexam).is('-Neck')"][checkbox name="examneckfreetext" memo="free text" memo_color="orange" memo_size="small" value=""][/conditional][conditional field="examneckfreetext" condition="(examneckfreetext).is('')"]--textarea rows="2" cols="100"]
[/conditional][conditional field="neckdetailexam" condition="(neckdetailexam).is('-Neck')"]
[/conditional][conditional field="detailedexam" condition="(detailedexam).is('')"][checkbox name="chestdetailexam" memo="*" value="-Chest"][/conditional][conditional field="chestdetailexam" condition="(chestdetailexam).is('-Chest')"] --[checkbox name="examchest" value="normal rise and fall B/L|no accessory muscle use"][checkbox name="examchestabn" memo="abnormals" memo_color="red" memo_size="small" value=""][/conditional][conditional field="examchestabn" condition="(examchestabn).is('')"]
--[checkbox name="examchestabn1" value="INTERCOSTAL RETRACTIONS|SUPRACOSTAL RETRACTIONS|INFRACOSTAL RETRACTIONS|PECTUS EXCAVATUM|PECTUS CARINATUM"]
[/conditional][conditional field="chestdetailexam" condition="(chestdetailexam).is('-Chest')"][checkbox name="examchestfreetext" memo="free text" value=""][/conditional][conditional field="examchestfreetext" condition="(examchestfreetext).is('')"]--[textarea rows="2" cols="100"]
[/conditional][conditional field="chestdetailexam" condition="(chestdetailexam).is('-Chest')"]
[/conditional][conditional field="detailedexam" condition="(detailedexam).is('')"][checkbox name="heartdetailexam" memo="*" value="-Heart"][/conditional][conditional field="heartdetailexam" condition="(heartdetailexam).is('-Heart')"] --[checkbox name="examheart" value="RRR|normal S1/S2|No M/R/G|No S3/S4 auscultated|no friction rub"][checkbox name="examheartabn" memo="abnormals" memo_color="red" memo_size="small" value=""][/conditional][conditional field="examheartabn" condition="(examheartabn).is('')"]--[checkbox name="examheartabn1" value="MURMUR AUSCULTATED"][/conditional][conditional field="examheartabn1" condition="(examheartabn1).is('MURMUR AUSCULTATED')"] - GRADE [text size="3"]/6 [select value="SYSTOLIC EJECTION|SYSTOLIC|DIASTOLIC|HOLOSYSTOLIC"] HEARD BEST AT [select value="R|L"] [select value="UPPER STERNAL BORDER|LOWER STERNAL BORDER|APEX"]
[/conditional][conditional field="heartdetailexam" condition="(heartdetailexam).is('-Heart')"][checkbox name="examheartfreetext" memo="free text" memo_color="orange" memo_size="small" value=""][/conditional][conditional field="examheartfreetext" condition="(examheartfreetext).is('')"]--[textarea rows="2" cols="100"]
[/conditional][conditional field="heartdetailexam" condition="(heartdetailexam).is('-Heart')"]
[/conditional][conditional field="detailedexam" condition="(detailedexam).is('')"][checkbox name="lungsdetailexam" memo="*" value="-Lungs"][/conditional][conditional field="lungsdetailexam" condition="(lungsdetailexam).is('-Lungs')"] -- [checkbox name="examlungs" value="CTAB|BSE b/l|no wheezes|no crackles|no rhonchi"][checkbox name="examlungsabn" memo="abnormals" memo_color="red" memo_size="small" value=""][/conditional][conditional field="examlungsabn" condition="(examlungsabn).is('')"]
[checkbox name="examlungsabn1" value="--WHEEZING-"][/conditional][conditional field="examlungsabn1" condition="(examlungsabn1).is('--WHEEZING-')"] [checkbox value="EXPIRATORY|INSPIRATORY|B/L LUNGS|R LUNG|L LUNG|DIFFUSE|LOWER FIELD(S)|UPPER FIELD(S)"]
[/conditional][conditional field="examlungsabn" condition="(examlungsabn).is('')"][checkbox name="examlungsabn2" value="--RHONCHI-"][/conditional][conditional field="examlungsabn2" condition="(examlungsabn2).is('--RHONCHI-')"] [checkbox value="EXPIRATORY|INSPIRATORY|B/L LUNGS|R LUNG|L LUNG|DIFFUSE|LOWER FIELD(S)|UPPER FIELD(S)"]
[/conditional][conditional field="examlungsabn" condition="(examlungsabn).is('')"][checkbox name="examlungsabn3" value="--BREATH SOUNDS DIMINISHED-"][/conditional][conditional field="examlungsabn3" condition="(examlungsabn3).is('--BREATH SOUNDS DIMINISHED-')"] [checkbox value="B/L LUNGS|R LUNG|L LUNG|DIFFUSE|LOWER FIELD(S)|UPPER FIELD(S)"].
[/conditional][conditional field="lungsdetailexam" condition="(lungsdetailexam).is('-Lungs')"][checkbox name="examlungfreetext" memo="free text" memo_color="orange" memo_size="small" value=""][/conditional][conditional field="examlungfreetext" condition="(examlungfreetext).is('')"]--[textarea rows="2" cols="100"]
[/conditional][conditional field="lungsdetailexam" condition="(lungsdetailexam).is('-Lungs')"]
[/conditional][conditional field="detailedexam" condition="(detailedexam).is('')"][checkbox name="ABDdetailexam" memo="*" value="-Abdomen"][/conditional][conditional field="ABDdetailexam" condition="(ABDdetailexam).is('')"] --[checkbox name="examABD" value="soft|nontender|nondistended|no voluntary/involuntary guarding|no rigidity|no rebound|bowel sounds present in all 4 quadrants"][checkbox name="examABDabn" memo="abnormals" memo_color="red" memo_size="small" value=""][/conditional][conditional field="examABDabn" condition="(examABDabn).is('')"]
[checkbox name="examABDabn1" value="--TTP-"][/conditional][conditional field="examABDabn1" condition="(examABDabn1).is('--TTP-')"] [checkbox value="MILD|MODERATE|EXQUISITE|OUT OF PROPORTION TO EXAM|RUQ|EPIGASTRIC AREA|LUQ|RLQ|LLQ|PERIUMBILICAL|SUPRAPUBIC"]
[/conditional][conditional field="examABDabn" condition="(examABDabn).is('')"][checkbox name="examABDabn2" value="--BOWEL SOUNDS-"][/conditional][conditional field="examABDabn2" condition="(examABDabn2).is('--BOWEL SOUNDS-')"] [checkbox value="HYPOACTIVE|HYPERACTIVE|RUQ|LUQ|RLQ|LLQ|DIFFUSELY"]
[/conditional][conditional field="examABDabn" condition="(examABDabn).is('')"][checkbox name="examABDabn3" value="--PALPABLE MASS-"][/conditional][conditional field="examABDabn3" condition="(examABDabn3).is('--PALPABLE MASS-')"] APPROXIMATE SIZE - [text size="5"] CM, [checkbox value="RUQ|LUQ|RLQ|LLQ|MIDLINE|PERIUMBILICAL|PULSATILE"]
[/conditional][conditional field="examABDabn" condition="(examABDabn).is('')"][checkbox name="examABDabn4" value="--VISIBLE SCAR(S)-"][/conditional][conditional field="examABDabn4" condition="(examABDabn4).is('--VISIBLE SCAR(S)-')"] [text size="80"]
[/conditional][conditional field="ABDdetailexam" condition="(ABDdetailexam).is('-Abdomen')"][checkbox name="examABDfreetext" memo="free text" memo_color="orange" memo_size="small" value=""][/conditional][conditional field="examABDfreetext" condition="(examABDfreetext).is('')"]--[textarea rows="2" cols="100"]
[/conditional][conditional field="ABDdetailexam" condition="(ABDdetailexam).is('-Abdomen')"]
[/conditional][conditional field="detailedexam" condition="(detailedexam).is('')"][checkbox name="GUdetailexam" memo="Genitourinary" value=""][/conditional][conditional field="GUdetailexam" condition="(GUdetailexam).is('')"]-GU -- [checkbox name="examGU" value="normal appearance of external genitalia|normal appearance of vagina|normal appearance of vaginal mucosa|no vaginal discharge|no cervical discharge|no CMT|no uterine tenderness|no adnexal tenderness|IUD string visualized"][checkbox name="examGUabn" memo="abnormals" memo_color="red" memo_size="small" value=""][/conditional][conditional field="examGUabn" condition="(examGUabn).is('')"]
[checkbox name="examGUabn1" value="--VAGINAL DISCHARGE-"][/conditional][conditional field="examGUabn1" condition="(examGUabn1).is('--VAGINAL DISCHARGE-')"] [text default="color/consistency-" size="80"]
[/conditional][conditional field="examGUabn" condition="(examGUabn).is('')"][checkbox name="examGUabn2" value="--VAGINAL MUCOSA-"][/conditional][conditional field="examGUabn2" condition="(examGUabn2).is('--VAGINAL MUCOSA-')"] [text size="80"]
[/conditional][conditional field="examGUabn" condition="(examGUabn).is('')"][checkbox value="--VAGINAL TENDERNESS
"][checkbox value="--CERVICAL MOTION TENDERNESS
"][checkbox name="examGUabn3" value="--CERVICAL DISCHARGE-"][/conditional][conditional field="examGUabn3" condition="(examGUabn3).is('--CERVICAL DISCHARGE-')"] [text default="color/consistency-" size="80"]
[/conditional][conditional field="examGUabn" condition="(examGUabn).is('')"][checkbox value="--ADNEXAL TENDERNESS
"][checkbox name="examGUabn4" value="--ADNEXAL MASS-"][/conditional][conditional field="examGUabn4" condition="(examGUabn4).is('--ADNEXAL MASS-')"] [text default="location-" size="80"]
[/conditional][conditional field="GUdetailexam" condition="(GUdetailexam).is('')"][checkbox name="examGUfreetext" memo="free text" memo_color="orange" memo_size="small" value=""][/conditional][conditional field="examGUfreetext" condition="(examGUfreetext).is('')"]--[textarea rows="2" cols="100"]
[/conditional][conditional field="GUdetailexam" condition="(GUdetailexam).is('')"]
[/conditional][conditional field="detailedexam" condition="(detailedexam).is('')"][checkbox name="skindetailexam" memo="Skin" value=""][/conditional][conditional field="skindetailexam" condition="(skindetailexam).is('')"]-Skin --[checkbox name="examskin" value="warm|dry|intact|no edema|no erythema|no ecchymosis"][checkbox name="examskinabn" memo="abnormals" memo_color="red" memo_size="small" value=""][/conditional][conditional field="examskinabn" condition="(examskinabn).is('')"]
[checkbox value="--JAUNDICED
"][checkbox value="--ACROCYANOSIS
"][checkbox name="examskinabn1" value="--RASH-"][/conditional][conditional field="examskinabn1" condition="(examskinabn1).is('--RASH-')"] LOCATION(S)- [checkbox value="FACE|FOREHEAD|ANTERIOR NECK|POSTERIOR NECK|ANTERIOR TRUNK|POSTERIOR TRUNK|R SHOULDER|L SHOULDER|R ARM|L ARM|R ELBOW|L ELBOW|R FOREARM|L FOREARM|R WRIST|L WRIST|R HAND DORSUM|L HAND DORSUM|R PALM|L PALM|R INGUINAL AREA|L INGUINAL AREA|R HIP|L HIP|R THIGH|L THIGH|R KNEE|L KNEE|R LEG|L LEG|R ANKLE|L ANKLE|R FOOT DORSUM|L FOOT DORSUM|R FOOT SOLE|L FOOT SOLE"]. DESCRIPTION- [checkbox name="examskinabn11" value="MACULAR|PAPULAR|LACEY APPEARANCE|PATCHY|SCATTERED|CLUSTERED|ROUGH TEXTURE|ERYTHEMATOUS|SKIN/FLESH COLORED|HYPERPIGMENTED|HYPOPIGMENTED|NON-BLANCHING|SCALY"]. ADDITIONAL DESCRIPTION: [textarea rows="2) cols="2"]
[/conditional][conditional field="examskinabn" condition="(examskinabn).is('')"][checkbox name="examskinabn2" value="--FOCAL/ISOLATED LESION(S)-"]
[/conditional][conditional field="examskinabn2" condition="(examskinabn2).is('--FOCAL/ISOLATED LESION(S)-')"][checkbox memo="1st Lesion" name="Lesion1" value=""][/conditional][conditional field="Lesion1" condition="(Lesion1).is('')"]--Lesion#1
---Location: [select name="skinexamlocation1" value="|Scalp|Face|Neck|Shoulder|Chest/Trunk|Abdomen|Buttocks|Inguinal|Male Genital Region|Female Genital Region|Arm|Elbow|Forearm|Wrist|Hand|Finger|Hip|Thigh|Knee|Leg|Ankle|Foot|Toe"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Scalp')"]- [select value="right|left|midline"] [select value="occipital|parietal|temporal|frontal|preauricular|postauricular"] area[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Face')"]- [select value="right|left|midline"] [select value="preauricular|mandibular angle|cheek|nose|periorbital|perioral|chin|submandibular|submental"] area[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Neck')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Shoulder')||(skinexamlocation1).is('Elbow')||(skinexamlocation1).is('Wrist')||(skinexamlocation1).is('Hip')||(skinexamlocation1).is('Knee')||(skinexamlocation1).is('Ankle')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Arm')||(skinexamlocation1).is('Forearm')||(skinexamlocation1).is('Thigh')||(skinexamlocation1).is('Leg')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Chest/Trunk')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Abdomen')"]- [select value="periumbilical|epigastrium|RUQ|LUQ|RLQ|LLQ"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Buttocks')"]- [select value="right|left|midline"] [select value="|medial|lateral"] [select value="perianal|gluteal cleft|cheek|gluteal fold"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Inguinal')"]- [select value="right|left"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Male Genital Region')"]- [select value="right|left|midline"] [select value="penile glans|penile shaft|base of penis|scrotum|periscrotal area"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Female Genital Region')"]- [select value="right|left|midline"] [select value="labia majora|labia minora|perilabial area|periclitoral area|mons pubis|perineum"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Hand')||(skinexamlocation1).is('Finger')"]- [select value="right|left"], [checkbox value="palmar/volar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Finger')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MCP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Foot')||(skinexamlocation1).is('Toe')"]- [select value="right|left"], [checkbox value="plantar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Toe')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MTP|proximal phalanx|middle phalanx|distal phalanx|periungual area"]
[/conditional][conditional field="Lesion1" condition="(Lesion1).is('')"]---Character/Texture: [checkbox name="skinexamlesion1" value="macule|papule|patch|plaque|rough|smooth|firm|soft|mobile|fixed|pedunculated|palpable subdermal lump|palpable subcutaneous lump"]
---Size: [text size="5"] cm
[/conditional][conditional field="skinexamlesion1" condition="(skinexamlesion1).is('macule')||(skinexamlesion1).is('papule')||(skinexamlesion1).is('patch')||(skinexamlesion1).is('plaque')||(skinexamlesion1).is('rough')||(skinexamlesion1).is('pedunculated')"]---Color: [select value="uniform color|non-uniform color"], [select value="erthythematous|flesh-color|brown|black|blue|multicolored"] [text size="20"]
---Borders: [select value="well-circumscribed|ill-defined"]
[/conditional][conditional field="Lesion1" condition="(Lesion1).is('')"][checkbox value="---Other features:"] [text size="40"]
[/conditional][conditional field="examskinabn2" condition="(examskinabn2).is('--FOCAL/ISOLATED LESION(S)-')"][checkbox memo="2nd Lesion" name="Lesion2" value=""][/conditional][conditional field="Lesion2" condition="(Lesion2).is('')"]--Lesion#2
---Location: [select name="skinexamlocation2" value="|Scalp|Face|Neck|Shoulder|Chest/Trunk|Abdomen|Buttocks|Inguinal|Male Genital Region|Female Genital Region|Arm|Elbow|Forearm|Wrist|Hand|Finger|Hip|Thigh|Knee|Leg|Ankle|Foot|Toe"][/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Scalp')"]- [select value="right|left|midline"] [select value="occipital|parietal|temporal|frontal|preauricular|postauricular"] area[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Face')"]- [select value="right|left|midline"] [select value="preauricular|mandibular angle|cheek|nose|periorbital|perioral|chin|submandibular|submental"] area[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Neck')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Shoulder')||(skinexamlocation2).is('Elbow')||(skinexamlocation2).is('Wrist')||(skinexamlocation2).is('Hip')||(skinexamlocation2).is('Knee')||(skinexamlocation2).is('Ankle')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Arm')||(skinexamlocation2).is('Forearm')||(skinexamlocation2).is('Thigh')||(skinexamlocation2).is('Leg')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Chest/Trunk')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Abdomen')"]- [select value="periumbilical|epigastrium|RUQ|LUQ|RLQ|LLQ"] aspect[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Buttocks')"]- [select value="right|left|midline"] [select value="|medial|lateral"] [select value="perianal|gluteal cleft|cheek|gluteal fold"][/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Inguinal')"]- [select value="right|left"][/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Male Genital Region')"]- [select value="right|left|midline"] [select value="penile glans|penile shaft|base of penis|scrotum|periscrotal area"][/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Female Genital Region')"]- [select value="right|left|midline"] [select value="labia majora|labia minora|perilabial area|periclitoral area|mons pubis|perineum"][/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Hand')||(skinexamlocation2).is('Finger')"]- [select value="right|left"], [checkbox value="palmar/volar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Finger')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MCP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Foot')||(skinexamlocation2).is('Toe')"]- [select value="right|left"], [checkbox value="plantar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Toe')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MTP|proximal phalanx|middle phalanx|distal phalanx|periungual area"]
[/conditional][conditional field="Lesion2" condition="(Lesion2).is('')"]---Character/Texture: [checkbox name="skinexamlesion2" value="macule|papule|patch|plaque|rough|smooth|firm|soft|mobile|fixed|pedunculated|palpable subdermal lump|palpable subcutaneous lump"]
---Size: [text size="5"] cm
[/conditional][conditional field="skinexamlesion2" condition="(skinexamlesion2).is('macule')||(skinexamlesion2).is('papule')||(skinexamlesion2).is('patch')||(skinexamlesion2).is('plaque')||(skinexamlesion2).is('rough')||(skinexamlesion2).is('pedunculated')"]---Color: [select value="uniform color|non-uniform color"], [select value="erthythematous|flesh-color|brown|black|blue|multicolored"] [text size="20"]
---Borders: [select value="well-circumscribed|ill-defined"]
[/conditional][conditional field="Lesion2" condition="(Lesion2).is('')"][checkbox value="---Other features:"] [text size="40"]
[/conditional][conditional field="examskinabn2" condition="(examskinabn2).is('--FOCAL/ISOLATED LESION(S)-')"][checkbox memo="3rd Lesion" name="Lesion3" value=""][/conditional][conditional field="Lesion3" condition="(Lesion3).is('')"]--Lesion#3
---Location: [select name="skinexamlocation3" value="|Scalp|Face|Neck|Shoulder|Chest/Trunk|Abdomen|Buttocks|Inguinal|Male Genital Region|Female Genital Region|Arm|Elbow|Forearm|Wrist|Hand|Finger|Hip|Thigh|Knee|Leg|Ankle|Foot|Toe"][/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Scalp')"]- [select value="right|left|midline"] [select value="occipital|parietal|temporal|frontal|preauricular|postauricular"] area[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Face')"]- [select value="right|left|midline"] [select value="preauricular|mandibular angle|cheek|nose|periorbital|perioral|chin|submandibular|submental"] area[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Neck')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Shoulder')||(skinexamlocation3).is('Elbow')||(skinexamlocation3).is('Wrist')||(skinexamlocation3).is('Hip')||(skinexamlocation3).is('Knee')||(skinexamlocation3).is('Ankle')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Arm')||(skinexamlocation3).is('Forearm')||(skinexamlocation3).is('Thigh')||(skinexamlocation3).is('Leg')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Chest/Trunk')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Abdomen')"]- [select value="periumbilical|epigastrium|RUQ|LUQ|RLQ|LLQ"] aspect[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Buttocks')"]- [select value="right|left|midline"] [select value="|medial|lateral"] [select value="perianal|gluteal cleft|cheek|gluteal fold"][/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Inguinal')"]- [select value="right|left"][/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Male Genital Region')"]- [select value="right|left|midline"] [select value="penile glans|penile shaft|base of penis|scrotum|periscrotal area"][/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Female Genital Region')"]- [select value="right|left|midline"] [select value="labia majora|labia minora|perilabial area|periclitoral area|mons pubis|perineum"][/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Hand')||(skinexamlocation3).is('Finger')"]- [select value="right|left"], [checkbox value="palmar/volar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Finger')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MCP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Foot')||(skinexamlocation3).is('Toe')"]- [select value="right|left"], [checkbox value="plantar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Toe')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MTP|proximal phalanx|middle phalanx|distal phalanx|periungual area"]
[/conditional][conditional field="Lesion3" condition="(Lesion3).is('')"]---Character/Texture: [checkbox name="skinexamlesion3" value="macule|papule|patch|plaque|rough|smooth|firm|soft|mobile|fixed|pedunculated|palpable subdermal lump|palpable subcutaneous lump"]
---Size: [text size="5"] cm
[/conditional][conditional field="skinexamlesion3" condition="(skinexamlesion3).is('macule')||(skinexamlesion3).is('papule')||(skinexamlesion3).is('patch')||(skinexamlesion3).is('plaque')||(skinexamlesion3).is('rough')||(skinexamlesion3).is('pedunculated')"]---Color: [select value="uniform color|non-uniform color"], [select value="erthythematous|flesh-color|brown|black|blue|multicolored"] [text size="20"]
---Borders: [select value="well-circumscribed|ill-defined"]
[/conditional][conditional field="Lesion3" condition="(Lesion3).is('')"][checkbox value="---Other features:"] [text size="40"]
[/conditional][conditional field="examskinabn2" condition="(examskinabn2).is('--FOCAL/ISOLATED LESION(S)-')"][checkbox memo="4th Lesion" name="Lesion4" value=""][/conditional][conditional field="Lesion4" condition="(Lesion4).is('')"]--Lesion#4
---Location: [select name="skinexamlocation4" value="|Scalp|Face|Neck|Shoulder|Chest/Trunk|Abdomen|Buttocks|Inguinal|Male Genital Region|Female Genital Region|Arm|Elbow|Forearm|Wrist|Hand|Finger|Hip|Thigh|Knee|Leg|Ankle|Foot|Toe"][/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Scalp')"]- [select value="right|left|midline"] [select value="occipital|parietal|temporal|frontal|preauricular|postauricular"] area[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Face')"]- [select value="right|left|midline"] [select value="preauricular|mandibular angle|cheek|nose|periorbital|perioral|chin|submandibular|submental"] area[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Neck')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Shoulder')||(skinexamlocation4).is('Elbow')||(skinexamlocation4).is('Wrist')||(skinexamlocation4).is('Hip')||(skinexamlocation4).is('Knee')||(skinexamlocation4).is('Ankle')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Arm')||(skinexamlocation4).is('Forearm')||(skinexamlocation4).is('Thigh')||(skinexamlocation4).is('Leg')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Chest/Trunk')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Abdomen')"]- [select value="periumbilical|epigastrium|RUQ|LUQ|RLQ|LLQ"] aspect[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Buttocks')"]- [select value="right|left|midline"] [select value="|medial|lateral"] [select value="perianal|gluteal cleft|cheek|gluteal fold"][/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Inguinal')"]- [select value="right|left"][/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Male Genital Region')"]- [select value="right|left|midline"] [select value="penile glans|penile shaft|base of penis|scrotum|periscrotal area"][/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Female Genital Region')"]- [select value="right|left|midline"] [select value="labia majora|labia minora|perilabial area|periclitoral area|mons pubis|perineum"][/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Hand')||(skinexamlocation4).is('Finger')"]- [select value="right|left"], [checkbox value="palmar/volar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Finger')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MCP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Foot')||(skinexamlocation4).is('Toe')"]- [select value="right|left"], [checkbox value="plantar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Toe')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MTP|proximal phalanx|middle phalanx|distal phalanx|periungual area"]
[/conditional][conditional field="Lesion4" condition="(Lesion4).is('')"]---Description:
---Character/Texture: [checkbox name="skinexamlesion4" value="macule|papule|patch|plaque|rough|smooth|firm|soft|mobile|fixed|pedunculated|palpable subdermal lump|palpable subcutaneous lump"]
---Size: [text size="5"] cm
[/conditional][conditional field="skinexamlesion4" condition="(skinexamlesion4).is('macule')||(skinexamlesion4).is('papule')||(skinexamlesion4).is('patch')||(skinexamlesion4).is('plaque')||(skinexamlesion4).is('rough')||(skinexamlesion4).is('pedunculated')"]---Color: [select value="uniform color|non-uniform color"], [select value="erthythematous|flesh-color|brown|black|blue|multicolored"] [text size="20"]
---Borders: [select value="well-circumscribed|ill-defined"]
[/conditional][conditional field="Lesion4" condition="(Lesion4).is('')"][checkbox value="---Other features:"] [text size="40"]
[/conditional][conditional field="examskinabn2" condition="(examskinabn2).is('--FOCAL/ISOLATED LESION(S)-')"][checkbox memo="5th Lesion" name="Lesion5" value=""][/conditional][conditional field="Lesion5" condition="(Lesion5).is('')"]--Lesion#5
---Location: [select name="skinexamlocation5" value="|Scalp|Face|Neck|Shoulder|Chest/Trunk|Abdomen|Buttocks|Inguinal|Male Genital Region|Female Genital Region|Arm|Elbow|Forearm|Wrist|Hand|Finger|Hip|Thigh|Knee|Leg|Ankle|Foot|Toe"][/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Scalp')"]- [select value="right|left|midline"] [select value="occipital|parietal|temporal|frontal|preauricular|postauricular"] area[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Face')"]- [select value="right|left|midline"] [select value="preauricular|mandibular angle|cheek|nose|periorbital|perioral|chin|submandibular|submental"] area[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Neck')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Shoulder')||(skinexamlocation5).is('Elbow')||(skinexamlocation5).is('Wrist')||(skinexamlocation5).is('Hip')||(skinexamlocation5).is('Knee')||(skinexamlocation5).is('Ankle')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Arm')||(skinexamlocation5).is('Forearm')||(skinexamlocation5).is('Thigh')||(skinexamlocation5).is('Leg')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Chest/Trunk')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Abdomen')"]- [select value="periumbilical|epigastrium|RUQ|LUQ|RLQ|LLQ"] aspect[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Buttocks')"]- [select value="right|left|midline"] [select value="|medial|lateral"] [select value="perianal|gluteal cleft|cheek|gluteal fold"][/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Inguinal')"]- [select value="right|left"][/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Male Genital Region')"]- [select value="right|left|midline"] [select value="penile glans|penile shaft|base of penis|scrotum|periscrotal area"][/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Female Genital Region')"]- [select value="right|left|midline"] [select value="labia majora|labia minora|perilabial area|periclitoral area|mons pubis|perineum"][/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Hand')||(skinexamlocation5).is('Finger')"]- [select value="right|left"], [checkbox value="palmar/volar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Finger')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MCP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Foot')||(skinexamlocation5).is('Toe')"]- [select value="right|left"], [checkbox value="plantar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Toe')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MTP|proximal phalanx|middle phalanx|distal phalanx|periungual area"]
[/conditional][conditional field="Lesion5" condition="(Lesion5).is('')"]---Character/Texture: [checkbox name="skinexamlesion5" value="macule|papule|patch|plaque|rough|smooth|firm|soft|mobile|fixed|pedunculated|palpable subdermal lump|palpable subcutaneous lump"]
---Size: [text size="5"] cm
[/conditional][conditional field="skinexamlesion5" condition="(skinexamlesion5).is('macule')||(skinexamlesion5).is('papule')||(skinexamlesion5).is('patch')||(skinexamlesion5).is('plaque')||(skinexamlesion5).is('rough')||(skinexamlesion5).is('pedunculated')"]---Color: [select value="uniform color|non-uniform color"], [select value="erthythematous|flesh-color|brown|black|blue|multicolored"] [text size="20"]
---Borders: [select value="well-circumscribed|ill-defined"]
[/conditional][conditional field="Lesion5" condition="(Lesion5).is('')"][checkbox value="---Other features:"] [text size="40"]
[/conditional][conditional field="skindetailexam" condition="(skindetailexam).is('')"][checkbox name="examskinfreetext" memo="free text" value=""][/conditional][conditional field="examskinfreetext" condition="(examskinfreetext).is('')"]--[textarea rows="2" cols="100"]
[/conditional][conditional field="skindetailexam" condition="(skindetailexam).is('')"]
[/conditional][conditional field="detailedexam" condition="(detailedexam).is('')"][checkbox name="EXTdetailexam" memo="Extremities" value=""][/conditional][conditional field="EXTdetailexam" condition="(EXTdetailexam).is('')"]-EXT --[checkbox name="examEXT" value="no gross deformities noted|no cyanosis|no clubbing|peripheral pulses 2/4 x4"][checkbox name="examEXTabn" memo="abnormals" value=""][/conditional][conditional field="examEXTabn" condition="(examEXTabn).is('')"]
[checkbox name="examEXTabn1" value="--CLUBBING-"][/conditional][conditional field="examEXTabn1" condition="(examEXTabn1).is('--CLUBBING-')"] [checkbox value="DIGITS UPPER EXTREMITY|GROSS DEFORMITY"] [text size="80"]
[/conditional][conditional field="EXTdetailexam" condition="(EXTdetailexam).is('')"][checkbox name="examEXTfreetext" memo="free text" value=""][/conditional][conditional field="examEXTfreetext" condition="(examEXTfreetext).is('')"] [textarea rows="2" cols="100"][/conditional][conditional field="EXTdetailexam" condition="(EXTdetailexam).is('')"]
[/conditional][conditional field="detailedexam" condition="(detailedexam).is('')"][checkbox name="NEUROdetailexam" memo="Neuro" value=""][/conditional][conditional field="NEUROdetailexam" condition="(NEUROdetailexam).is('')"]-Neuro [checkbox name="examNEUROnorm" memo="normals" memo_size="small" value=""][/conditional][conditional field="examNEUROnorm" condition="(examNEUROnorm).is('')"]
--[checkbox name="examNEURO" value="mentating well|moves all extremities equally well|CN 2-12 grossly intact b/l|normal sensorium all 4 extremities|no gross motor deficits|Romberg negative|cerebellar testing normal|DTRs 2/4 x4|gait testing without abnormalities"].
[/conditional][conditional field="NEUROdetailexam" condition="(NEUROdetailexam).is('')"][checkbox name="examNEUROabn" memo="abnormals" memo_color="red" memo_size="small" value=""][/conditional][conditional field="examNEUROabn" condition="(examNEUROabn).is('')"][checkbox name="examNEUROabn1" value="--SENSORY DEFICIT(S)-"][/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"]
[checkbox name="examNEUROabn11" value="---Scalp- "][/conditional][conditional field="examNEUROabn11" condition="(examNEUROabn11).is('---Scalp- ')"][checkbox value="R occipital|L occipital|R parietal|L parietal|R temporal|L temporal|R frontal|L frontal|R preauricular|L preauricular|R postauricular|L postauricular"] area(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn12" value="---Face- "][/conditional][conditional field="examNEUROabn12" condition="(examNEUROabn12).is('---Face- ')"][checkbox value="R preauricular|L preauricular|R mandibular angle|L mandibular angle|R cheek|L cheek|R nasal bridge|L nasal bridge|R periorbital|L periorbital|R perioral|L perioral|chin|R submandibular|L submandibular|submental"] area(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn13" value="---Neck- "][/conditional][conditional field="examNEUROabn13" condition="(examNEUROabn13).is('---Neck- ')"][select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn14" value="---Shoulder- "][/conditional][conditional field="examNEUROabn14" condition="(examNEUROabn14).is('---Shoulder- ')"][checkbox value="right|left|anterior|posterior|medial|lateral"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn15" value="---Chest/Trunk- "][/conditional][conditional field="examNEUROabn15" condition="(examNEUROabn15).is('---Chest/Trunk- ')"][select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn16" value="---Abdomen- "][/conditional][conditional field="examNEUROabn16" condition="(examNEUROabn16).is('---Abdomen- ')"][checkbox value="periumbilical|epigastrium|RUQ|LUQ|RLQ|LLQ"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn17" value="---Buttocks- "][/conditional][conditional field="examNEUROabn17" condition="(examNEUROabn17).is('---Buttocks- ')"][checkbox value="right|left|midline|medial|lateral|perianal|gluteal cleft|cheek|gluteal fold|saddle"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn18" value="---Inguinal- "][/conditional][conditional field="examNEUROabn18" condition="(examNEUROabn18).is('---Inguinal- ')"][checkbox value="right|left|superior|inferior|medial|lateral"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn19" value="---Male Genital- "][/conditional][conditional field="examNEUROabn19" condition="(examNEUROabn19).is('---Male Genital- ')"][checkbox value="right|left|midline|b/l|penile glans|penile shaft|base of penis|scrotum|periscrotal"]aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn111" value="---Female Genital- "][/conditional][conditional field="examNEUROabn111" condition="(examNEUROabn111).is('---Female Genital- ')"][checkbox value="right|left|midline|labia majora|labia minora|perilabial area|periclitoral area|mons pubis|perineum"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn112" value="---Arm- "][/conditional][conditional field="examNEUROabn112" condition="(examNEUROabn112).is('---Arm- ')"][checkbox value="right|left|anterior|posterior|medial|lateral|superior|inferior|middle"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn113" value="---Elbow- "][/conditional][conditional field="examNEUROabn113" condition="(examNEUROabn113).is('---Elbow- ')"][checkbox value="="right|left|anterior|posterior|medial|lateral|antecubital|olecranon|epicondylar"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn114" value="---Forearm- "][/conditional][conditional field="examNEUROabn114" condition="(examNEUROabn114).is('---Forearm- ')"][checkbox value="="right|left|anterior|posterior|medial|lateral|distal|proximal"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn115" value="---Wrist- "][/conditional][conditional field="examNEUROabn115" condition="(examNEUROabn115).is('---Wrist- ')"][checkbox value="="right|left|anterior|posterior|volar|dorsal|medial|lateral"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn116" value="---Hand/Finger(s)- "][/conditional][conditional field="examNEUROabn116" condition="(examNEUROabn116).is('---Hand/Finger(s)- ')"][checkbox value="right|left|palmar/volar hand|dorsal hand|medial|lateral|thenar|hypothenar|1st digit|2nd digit|3rd digit|4th digit|5th digit|MCP|proximal phalanx|middle phalanx|distal phalanx|periungual|dorsal|volar|medial|lateral"]aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn117" value="---Hip- "][/conditional][conditional field="examNEUROabn117" condition="(examNEUROabn117).is('---Hip- ')"][checkbox value="right|left|anterior|posterior|medial|lateral"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn118" value="---Thigh- "][/conditional][conditional field="examNEUROabn118" condition="(examNEUROabn118).is('---Thigh- ')"][checkbox value="right|left|anterior|posterior|medial|lateral|superior|inferior|middle"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn119" value="---Knee- "][/conditional][conditional field="examNEUROabn119" condition="(examNEUROabn119).is('---Knee- ')"][checkbox value="right|left|anterior|posterior|medial|lateral"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn120" value="---Leg- "][/conditional][conditional field="examNEUROabn120" condition="(examNEUROabn120).is('---Leg- ')"][checkbox value="right|left|anterior|posterior|medial|lateral|superior|inferior|middle"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn121" value="---Ankle- "][/conditional][conditional field="examNEUROabn121" condition="(examNEUROabn121).is('---Ankle- ')"][checkbox value="right|left|anterior|posterior|medial|lateral"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('--SENSORY DEFICIT(S)-')"][checkbox name="examNEUROabn122" value="---Foot/Toe(s)- "][/conditional][conditional field="examNEUROabn122" condition="(examNEUROabn122).is('---Foot/Toe(s)- ')"][checkbox value="right|left|plantar|dorsal|medial|lateral|distal|proximal|1st digit|2nd digit|3rd digit|4th digit|5th digit|MTP|proximal phalanx|middle phalanx|distal phalanx|periungual area"] aspect(s). [textarea cols="2" memo="description if needed"memo_size="small"]
[/conditional][conditional field="examNEUROabn" condition="(examNEUROabn).is('')"]-[checkbox name="examNEUROabn2" value="--MOTOR DEFICIT(S)-"][/conditional][conditional field="examNEUROabn2" condition="(examNEUROabn2).is('--MOTOR DEFICIT(S)-')"]
--[checkbox name="examNEUROabn21" value="R UPPER EXTREMITY"][/conditional][conditional field="examNEUROabn21" condition="(examNEUROabn21).is('R UPPER EXTREMITY')"] STRENGTH [text size="5"]/5
[/conditional][conditional field="examNEUROabn2" condition="(examNEUROabn2).is('--MOTOR DEFICIT(S)-')"]--[checkbox name="examNEUROabn22" value="L UPPER EXTREMITY"][/conditional][conditional field="examNEUROabn22" condition="(examNEUROabn22).is('L UPPER EXTREMITY')"] STRENGTH [text size="5"]/5
[/conditional][conditional field="examNEUROabn2" condition="(examNEUROabn2).is('--MOTOR DEFICIT(S)-')"]--[checkbox name="examNEUROabn23" value="R LOWER EXTREMITY"][/conditional][conditional field="examNEUROabn23" condition="(examNEUROabn23).is('R LOWER EXTREMITY')"] STRENGTH [text size="5"]/5
[/conditional][conditional field="examNEUROabn2" condition="(examNEUROabn2).is('--MOTOR DEFICIT(S)-')"]--[checkbox name="examNEUROabn24" value="L LOWER EXTREMITY"][/conditional][conditional field="examNEUROabn24" condition="(examNEUROabn24).is('L LOWER EXTREMITY')"] STRENGTH [text size="5"]/5
[/conditional][conditional field="examNEUROabn2" condition="(examNEUROabn2).is('--MOTOR DEFICIT(S)-')"]--DEFICIT DETAILS [text size="80"]
[/conditional][conditional field="examNEUROabn" condition="(examNEUROabn).is('')"][checkbox name="examNEUROabn3" value="--ABNORMAL REFLEXES-"][/conditional][conditional field="examNEUROabn3" condition="(examNEUROabn3).is('--ABNORMAL REFLEXES-')"] [checkbox value="BICEPS|TRICEPS|BRACIORADIALIS|PATELLAR|ACHILLES"] - [text size="80"].
[/conditional][conditional field="examNEUROabn" condition="(examNEUROabn).is('')"][checkbox name="examNEUROabn4" value="--CEREBELLAR DEFICITS-"][/conditional][conditional field="examNEUROabn4" condition="(examNEUROabn4).is('--CEREBELLAR DEFICITS-')"] [checkbox value="POSITIVE ROMBERG|PRONATOR DRIFT|IMPAIRED FINGER-TO-NOSE|IMPAIRED HAND PRONATE/SUPINATE|IMPARIED HEEL-TO-SHIN"]. [text size="80"].
[/conditional][conditional field="examNEUROabn" condition="(examNEUROabn).is('')"][checkbox name="examNEUROabn5" value="--GAIT-"][/conditional][conditional field="examNEUROabn5" condition="(examNEUROabn5).is('--GAIT-')"] [checkbox value="HEMIPLEGIC|DIPLEGIC|NEUROPATHIC|CHOREIFORM|ATAXIC|PARKINSONIAN"]. [text size="80"]. [/conditional][conditional field="NEUROdetailexam" condition="(NEUROdetailexam).is('')"][checkbox name="examNEUROfreetext" memo="free text" value=""][/conditional][conditional field="examNEUROfreetext" condition="(examNEUROfreetext).is('')"] [textarea rows="2" cols="100"]
[/conditional][conditional field="NEUROdetailexam" condition="(NEUROdetailexam).is('')"]
[/conditional]
PHYSICAL EXAM
Chaperone Vitals Brief Visual Exam Detailed Exam
Result - Copy and paste this output: