WNL General Adult Survey

[var name="Date:"][date name="variable_1" default="11-20-2023"]
[var name="Name:"][text name="variable_1" default=""]
[var name="DOB:"][text name="variable_1" default=""]
[var name="Sex:"][radio name="variable_1" value="Male|Female|Other"]
[select name="2" value="Assessed|Not Assessed"][conditional field="2" condition="Not Assessed"]Not Assessed[/conditional][var name="General:"][textarea name="variable_1" default="Awake, alert and oriented. No acute distress. Well developed, hydrated and nourished. Appears stated age."]
[var name="Skin:"][textarea name="variable_1" default="Skin is warm, dry and intact without rashes or lesions. Appropriate color for ethnicity. Nailbeds pink with no cyanosis or clubbing."]
[var name="Head:"][textarea name="variable_1" default="The head is normocephalic and atraumatic without tenderness, visible or palpable masses, depressions, or scarring. Hair is of normal texture and evenly distributed."]
[var name="Eyes:"][textarea name="variable_1" default="Visual acuity is 20/20 without corrective lenses. Conjunctivae are clear without exudates or hemorrhage. Sclera is non-icteric. EOM are intact, PERRLA. Fundi appear normal including optic discs and vessels. No signs of nystagmus. Eyelids are normal in appearance without swelling or lesions."]
[var name="Ears:"][textarea name="variable_1" default="The external ear and ear canal are non-tender and without swelling. The canal is clear without discharge. The tympanic membrane is normal in appearance with normal landmarks and cone of light. Hearing is intact with good acuity to whispered voice."]
[var name="Nose:"][textarea name="variable_1" default="Nasal mucosa is pink and moist. The nasal septum is midline. Nares are patent bilaterally."]
[var name="Throat:"][textarea name="variable_1" default="Oral mucosa is pink and moist with good dentition. Tongue normal in appearance without lesions and with good symmetrical movement. No buccal nodules or lesions are noted. The pharynx is normal in appearance without tonsillar swelling or exudates."]
[var name="Neck:"][textarea name="variable_1" default="The neck is supple without adenopathy. Trachea is midline. Thyroid gland is normal without masses. Carotid pulse 2+ bilaterally without bruit. No JVD."]
[var name="Cardiac:"][textarea name="variable_1" default="The external chest is normal in appearance without lifts, heaves, or thrills. PMI is not visible and is palpated in the 5th intercostal space at the midclavicular line. Heart rate and rhythm are normal. No murmurs, gallops, or rubs are auscultated. S1 and S2 are heard and are of normal intensity."]
[var name="Respiratory:"][textarea name="variable_1" default="The chest wall is symmetric and without deformity. No signs of trauma. Chest wall is non-tender. No signs of respiratory distress. Lung sounds are clear in all lobes bilaterally without rales, ronchi, or wheezes."]
[var name="Abdominal:"][textarea name="variable_1" default="Abdomen is soft, symmetric, and non-tender without distention. There are no visible lesions or scars. The aorta is midline without bruit or visible pulsation. Umbilicus is midline without herniation. Bowel sounds are present and normoactive in all four quadrants. No masses, hepatomegaly, or splenomegaly are noted."]
[var name="Rectal:"][textarea name="variable_1" default="Normal rectal sphincter tone. No external masses or lesions. Stool is normal in appearance. guac negative."] 
[var name="Genital:"][textarea name="variable_1" default="Male: External genitalia is normal in appearance without lesions, swelling, masses or tenderness.                                                              Female: Vagina is pink and moist without lesions or discharge. Cervix is non-tender without lesions or erosions. Uterus is anteflexed, non-tender and normal in size. Ovaries are non-tender without palpable masses or enlargement."]
[var name="Spine:"][var name="variable_name"][textarea name="variable_1" default="Neck and back are without deformity, external skin changes, or signs of trauma. Curvature of the cervical, thoracic, and lumbar spine are within normal limits. Bony features of the shoulders and hips are of equal height bilaterally. Posture is upright, gait is smooth, steady, and within normal limits. No tenderness noted on palpation of the spinous processes. Spinous processes are midline. Cervical, thoracic, and lumbar paraspinal muscles are not tender and are without spasm. No discomfort is noted with flexion, extension, and side-to-side rotation of the cervical spine, full range of motion is noted. Full range of motion including flexion, extension, and side-to-side rotation of the thoracic and lumbar spine are noted and without discomfort. Straight leg raise test is negative bilaterally. Sensation to the upper and lower extremities is normal bilaterally. No clonus is noted. Grip strength is normal bilaterally. Dorsi/plantar flexion is normal bilaterally."]
[var name="Extremities:"][textarea name="variable_1" default="Upper and lower extremities are atraumatic in appearance without tenderness or deformity. No swelling or erythema. Full range of motion is noted to all joints. Muscle strength is 5/5 bilaterally. Tendon function is normal. Capillary refill is less than 3 seconds in all extremities. Pulses palpable. Steady gait noted."]
[var name="Neurological:"][textarea name="variable_1" default="The patient is awake, alert and oriented to person, place, and time with normal speech. Motor function is normal with muscle strength 5/5 bilaterally to upper and lower extremities. Sensation is intact bilaterally. Reflexes 2+ bilaterally. Cranial nerves are intact. Cerebellar function is intact. Memory is normal and thought process is intact. No gait abnormalities are appreciated."]
[var name="Psychiatric:"][textarea name="variable_1" default="Appropriate mood and affect. Good judgement and insight. No visual or auditory hallucinations. No suicidal or homicidal ideation."]

















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