physical

--General Appearance: 
LOC:[checklist name="field_name" value="Alert|Awake|Aware|Asleep|Responds to Verbal Stimulus|Responds to Pain|Unresponsive |Lethargic|Unconscious"]
Gait: [text name="field_name" default="sample text"] 
Hygiene and Grooming:[text name="field_name" default="sample text"]
Affect:[text name="field_name" default="sample text"]
Nutrition: [checklist name="field_name" value="well-nourished|cachexic"]
Distress: [checklist name="field_name" value="observable pain cues|appears in no acute distress"]

--HEENT: 
HEAD: Saw on insepction: [checkbox name="field_name" value="NC/AT"] [text name="field_name" default="sample text"].
EYES: Saw on inspection: [checklist name="field_name" value="PERRLA|EOMI|anticeteric|Injection|No injection|Papilledema|No papilledema|Cornea clear|cornea cloudy"], Fundus: [text name="field_name" default="sample text"], Eyebrows:[text name="field_name" default="sample text"] eyelids: [text name="field_name" default="sample text"] sclera: [text name="field_name" default="sample text"], Conjuctiva: [text name="field_name" default="sample text"]. Felt on Palpation: [text name="field_name" default="sample text"]. Snellen: [text name="field_name" default="sample text"]. Jaeger Chart: [text name="field_name" default="sample text"]. Ichihara Chart: [text name="field_name" default="sample text"]
EARS: Saw on inspection: [checklist name="field_name" value="discharge|no discharge|inflammation|no inflammation|TM intact|TM not intact|TM bulging|TM Concave|TM Gray|TM Discolored|TM cloudy|Visible bony structures"]. Felt On Palpation: [text name="field_name" default="sample text"]. Weber Test: [text name="field_name" default="sample text"]. Rinne Test: 
Nose: Saw on inspection: [checklist name="field_name" value="Nares red|nose symmetric|nose assymetric|Nares patent|Nares not patent|Mucous membranes moist and pink| mucous membranes moist and red|mucous membranes moist and grey|polyps present|no septal defect|septal defect"] [text name="field_name" default="sample text"], discharge: [text name="field_name" default="sample text"]. Felt on palpation: Frontal Sinuses: [text name="field_name" default="sample text"] Maxillary Sinuses: [text name="field_name" default="sample text"], Trans-illumination: [text name="field_name" default="sample text"], [text name="field_name" default="sample text"]
Mouth/Throat: Saw on inspection: Lips:
[text name="field_name" default="sample text"], Dental Caries: [text name="field_name" default="sample text"], Alignment: [text name="field_name" default="sample text"], Oropharynx: [text name="field_name" default="sample text"], Uvula: [text name="field_name" default="sample text"], Tonsils: [text name="field_name" default="sample text"], Tongue: [text name="field_name" default="sample text"], Gag Reflex: [select name="field_name" value="present|not present"]. [text name="field_name" default="sample text"]

--NECK: Saw on inspection [checklist name="field_name" value="Visible goiter|No visible Goiter|Edema|Discoloration"] [text name="field_name" default="sample text"], Felt on palpation: [checklist name="field_name" value="thrill|no thrill|LAD|No LAD|Neck supple|Neck rigid"] [text name="field_name" default="sample text"]. Lymph nodes: Aneterior Cervical: [text name="field_name" default="sample text"]. Posterior Cervical:[text name="field_name" default="sample text"]
Tosillar: [text name="field_name" default="sample text"] Sub-mandibular: [text name="field_name" default="sample text"]
Sub-Mental: [text name="field_name" default="sample text"] Supraclavicular: [text name="field_name" default="sample text"]. Heard on Auscultation: Bruit|No Bruit"] [text name="field_name" default="sample text"]

--RESPIRATORY: 
[textarea name="field_name" default="LUNGS: symmetric expansion/accessory muscle use/no accessory muscle use/barrel chest/Clear to auscultation and percussion/dimished breath sounds/areas of consolidation/without rales/with rales/without rhonchi/with rhonchi/audible wheeze/no wheezing/audible stridor/clubbing/no clubbing"] 
Cyanosis: [text name="field_name" default="sample text"]

--CARDIOVASCULAR:
[checkbox value="S1/S2, no S3/S4|soft S1, normal S2, no S3/S4|S1/S2, S3 present, no S4|S1/S2, no S3, S4 present|no murmur|holosystolic murmur|midsystolic murmur|late systolic murmur|diastolic murmur|loudness 1/6|loudness 2/6|loudness 3/6|loudness 4/6|loudness 5/6|loudness 6/6|rhythm is regular|rhythm is irregular|rhythm is irregularly irregular"][checkbox name="pulses" value="Peripheral pulses are 2+ throughout|Peripheral pulses are diminished|Peripheral pulses exam - "][conditional field="pulses" condition="(pulses).is('Peripheral pulses exam - ')"][text][/conditional][checkbox name="carotids" value="No carotid bruits|Carotid bruits on the left|Carotid bruits on the right|Bilateral Carotid bruits|Carotid pulses exam - "][conditional field="carotids" condition="(carotids).is('Carotid pulses exam - ')"][text][/conditional]. JVP: [text name="field_name" default="sample text"], Heaves/Lifts: [text name="field_name" default="sample text"] PMI:[text name="field_name" default="sample text"], [text name="field_name" default="sample text"], 

--MUSCULOSKELETAL:
--JOINTS: 
[textarea name="field_name" default="sample text"]
[textarea default="Neck: Range of motion with normal flexion, extension, right rotation, and left rotation. There is no palpable paraspinal muscle spasm."]
[textarea default="Upper extremity muscle strength is normal bilaterally. Sensation is normal bilaterally. Reflexes: normal and symmetric at biceps, triceps, brachioradialis"]
[textarea default="C spine x-ray: normal, without loss of cervical lordosis, no degenerative changes"][/conditional][conditional field="Q1" condition="(Q1).is('Back Pain')"]
[textarea default="General Appearance: No distress. Patient able to ambulate well. Gait is not antalgic."]
[textarea default="Straight leg raising negative bilaterally for radicular symptoms."]
[textarea default="Sensory exam in the legs is normal. "]
[textarea default="Knee reflexes are normal and symmetric."]
[textarea default="Ankle reflexes are normal and symmetric"]
[textarea default="Strength is normal and symmetric."]
[textarea default="No paraspinal muscle spasm. There is no midline tenderness. ROM of spine with normal flexion, extension, lateral range of motion to the right and left, and rotation to the right and left."][/conditional][conditional field="Q1" condition="(Q1).is('Shoulder Pain')"]
[textarea default="General Appearance: no acute distress"]
[textarea default="Neck: Range of motion with normal flexion, extension, right rotation, and left rotation. There is no palpable paraspinal muscle spasm."]
[textarea default="Shoulder: Symmetrical bilaterally, FROM flex/ex/IR/ER/abduction/adduction, No erythema or edema, Nontender to palpation, Negative: Hawkins, Neers, Yergusons, Speeds, empty can, 5/5 strength biceps/triceps/grip, Radial pulse full. Cap refill <2 seconds, Sensory intact to light touch distally."][/conditional][conditional field="Q1" condition="(Q1).is('Knee Pain')"]
[textarea default="General Appearance: no acute distress
[textarea default="Knee: Normal joint contours. No effusion. Normal range of motion. Normal strength on extension and flexion against resistance. No joint line pain medially or laterally. McMurray negative for crepitus and pain medially and laterally. There is no swelling or pain over the pes anserine bursa. Collateral ligament testing shows no laxity or pain. Anterior drawer test and Lachman shows no anterior cruciate laxity. Posterior drawer negative for laxity as well. No popliteal mass or palpable tenderness."][/conditional]

--GASTROINTESTINAL:
[conditional field="short" condition="(short).is('')"][textarea cols=80 rows=5 default="ABDOMEN: soft, flat, nontender without masses or hepatosplenomegaly. Bowel sounds active. No bruits."][/conditional][checkbox memo="Long Version" name="long" value=""][conditional field="long" condition="(long).is('')"][textarea cols=80 rows=5 default="ABDOMEN: ***obese/soft/flat/rigid/distended/tympany to percussion/hepatomegaly/splenomegaly/RUQ scar/midline scar/RLQ scar/suprapubic scar/right flank scar/left flank scar***
"]
[textarea cols=80 rows=5 default="***bowel sounds active/decreased bowel sounds/increased bowel sounds/no bruits/abdominal bruit at ---/right femoral artery bruit/left femoral artery bruit/bilateral femoral bruits***"]
[textarea cols=80 rows=5 default="***no guarding/no rebound tenderness/no abdominal tenderness to palpation/suprapubic tenderness/diffuse tenderness/tender to palpation at ---/RLQ tenderness/rebound tenderness/diminished bowel sounds/hyperactive bowel sounds/guarding/Rovsing's positive/mass at ---/hernia at ---***"][/conditional]

--GENITOURINARY:
[textarea name="field_name" default="Bladder distended/bladder nondistended, Bladder firm/Bladder soft/no tenderness/suprapubic tenderness/rash to perineum/urethral meatus patent/circumcised/not circumcised/rugae present/rugae absent/moist pink vulva/uterine prolapse present/stage I/stage II/stage III/rectal prolapse present/anal wink present/anal wink absent/BCR present/BCR absent/rectal tone present/gaping anus/rectal tone impaired/stool in rectal vault/no stool in rectal vault/rectal mass present"]. Prostate: [text name="field_name" default="sample text"] 
PVR: [text name="field_name" default="sample text"]. [text name="field_name" default="sample text"]

--INTEGUMENTARY:
[textarea name="field_name" default="skin warm/skin cool/skin hot/flushing/diaphoretic/poor skin turgor/good skin turgor/dry skin/xerosis/friable/pale/yellow/petechiae/purpura"].
Wounds: 
[textarea name="field_name" default="sample text"]
Rashes: 
[textarea name="field_name" default="sample text"]
Scars:
[textarea name="field_name" default="sample text"]

--NEUROLOGIC: 
Gait: [select name="G1" value="steady coordinated gait|abnormal"][conditional field="G1" condition="(G1).is('abnormal')"][checkbox value="an unsteady uncoordinated gait|a slow unsteady gait|walks on heels and toes with out problems|has difficulty with walking"][/conditional] [text]
Rhomberg: [select value="negative|postive"] [text]
Rapid alternating movements: [select value="normal|abnormal"] [text]
Cranial nerves: [select value="II-XII intact|abnormal"] [text]
cranial nerves II-XII intact.
Sensation: [select value="intact and symmetric at upper and lower extremities bilaterally|abnormal"] [text]
Strength: [select value="intact and symmetric at upper and lower extremities bilaterally|abnormal"] [text]
Reflexes:
[checkbox memo="Right Biceps" name="RB" value=""][conditional field="RB" condition="(RB).is('')"]Right Biceps: [select value="2+ (normal). |0 (absent). |1+ (hypoactive). |2+ (normal). |3+ (hyperactive without clonus). |4+ (hyperactive with clonus). "][/conditional][checkbox memo="Left Biceps" name="LB" value=""][conditional field="LB" condition="(LB).is('')"]Left Biceps: [select value="2+ (normal). |0 (absent). |1+ (hypoactive). |2+ (normal). |3+ (hyperactive without clonus). |4+ (hyperactive with clonus). "][/conditional][checkbox memo="Right Triceps" name="RT" value=""][conditional field="RT" condition="(RT).is('')"]Right Triceps: [select value="2+ (normal). |0 (absent). |1+ (hypoactive). |2+ (normal). |3+ (hyperactive without clonus). |4+ (hyperactive with clonus). "][/conditional][checkbox memo="Left Triceps" name="LT" value=""][conditional field="LT" condition="(LT).is('')"]Left Triceps: [select value="2+ (normal). |0 (absent). |1+ (hypoactive). |2+ (normal). |3+ (hyperactive without clonus). |4+ (hyperactive with clonus). "][/conditional][checkbox memo="Right Forearm" name="RF" value=""][conditional field="RF" condition="(RF).is('')"]Right Forearm: [select value="2+ (normal). |0 (absent). |1+ (hypoactive). |2+ (normal). |3+ (hyperactive without clonus). |4+ (hyperactive with clonus). "][/conditional][checkbox memo="Left Forearm" name="LF" value=""][conditional field="LF" condition="(LF).is('')"]Left Forearm: [select value="2+ (normal). |0 (absent). |1+ (hypoactive). |2+ (normal). |3+ (hyperactive without clonus). |4+ (hyperactive with clonus). "][/conditional][checkbox memo="Right Patella" name="RP" value=""][conditional field="RP" condition="(RP).is('')"]Right Patella: [select value="2+ (normal). |0 (absent). |1+ (hypoactive). |2+ (normal). |3+ (hyperactive without clonus). |4+ (hyperactive with clonus). "][/conditional][checkbox memo="Left Patella" name="LP" value=""][conditional field="LP" condition="(LP).is('')"]Left Patella: [select value="2+ (normal). |0 (absent). |1+ (hypoactive). |2+ (normal). |3+ (hyperactive without clonus). |4+ (hyperactive with clonus). "][/conditional][checkbox memo="Right Ankle" name="RA" value=""][conditional field="RA" condition="(RA).is('')"]Right Ankle: [select value="2+ (normal). |0 (absent). |1+ (hypoactive). |2+ (normal). |3+ (hyperactive without clonus). |4+ (hyperactive with clonus). "][/conditional][checkbox memo="Left Ankle" name="LA" value=""][conditional field="LA" condition="(LA).is('')"]Left Ankle: [select value="2+ (normal). |0 (absent). |1+ (hypoactive). |2+ (normal). |3+ (hyperactive without clonus). |4+ (hyperactive with clonus). "][/conditional]
Babinski: [select value="negative|postive"] [text]
The following other neurologic findings were found: [textarea default="none"]

--BREAST:
[text size=80 default="No chest deformity, asymmetry. Normal contours. No nodules, masses, tenderness, or axillary adenopathy. No nipple discharge."][comment memo="Enter abnormal details below..."]
[select value="|Left side:|Right side:"] [checkbox value="dimpling|mastectomy|fibrocystic changes|breast tenderness|muscle tenderness|dominant mass|nipple discharge|axillary adenopathy"] [text]
[select value="|Left side:|Right side:"] [checkbox value="dimpling|mastectomy|fibrocystic changes|breast tenderness|muscle tenderness|dominant mass|nipple discharge|axillary adenopathy"] [text]