Assessment and Plan – Adult Well Visit

A/P:
#WELL ADULT VISIT for [text name="wellvisitAPage" memo="age" memo_size="small" size="5"] yo [select name="wellvisitAPgender" memo="gender" memo_size="small" value="|M|F"][conditional field="wellvisitAPgender|wellvisitAPage" condition="((wellvisitAPgender).is('F'))&&((wellvisitAPage).isGreaterOrEqual('30')&&(wellvisitAPage).isLessOrEqual('64'))"] - [select name="wellvisitAPmenopause" value="premenopausal|perimenopausal|postmenopausal"][/conditional]
-tobacco status [select name="wellvisitAPtobacco" value="never|current|former"]
-BMI status [select name="wellvisitAPBMI" value="normal (18.5-25)|overweight (25-30)|obese (>30)"]
-high-risk sexual behavior [select name="wellvisitAPhighrisksex" value="no|yes"]

-Spent [text size="5"] minutes discussing the following preventative health topics and screenings:
[comment memo="USPSTF Guidelines (A/B Recommendations)" memo_size="small" memo_color="blue"][conditional field="wellvisitAPage|wellvisitAPgender|wellvisitAPtobacco" condition="((wellvisitAPage).isGreaterOrEqual('65')&&(wellvisitAPage).isLessOrEqual('75'))&&((wellvisitAPgender).is('M'))&&((wellvisitAPtobacco).is('current')||(wellvisitAPtobacco).is('former'))"][checkbox memo="M 65-75yo who haved smoked" memo_size="small" memo_color="yellow" name="USPSTFg1" value=" -AAA U/S screening"][/conditional][conditional field="USPSTFg1" condition="(USPSTFg1).is(' -AAA U/S screening')"] - [checkbox value="patient declined|patient accepted|ordered"]
[/conditional][conditional field="wellvisitAPage" condition="(wellvisitAPage).isGreaterOrEqual('50')&&(wellvisitAPage).isLessOrEqual('59')"][checkbox memo="M/F 50-59yo with >10% CV risk" memo_size="small" memo_color="yellow" name="USPSTFg2" value=" -ASA for Primary CVD prevention"][/conditional][conditional field="USPSTFg2" condition="(USPSTFg2).is(' -ASA for Primary CVD prevention')"] - [checkbox value="patient declined|patient accepted/agreed|ordered"]
[/conditional][conditional field="wellvisitAPage|wellvisitAPgender" condition="((wellvisitAPage).isGreaterOrEqual('21')&&(wellvisitAPage).isLessOrEqual('65'))&&((wellvisitAPgender).is('F'))"][checkbox memo="F 21-65yo" memo_size="small" memo_color="yellow" name="USPSTFg6" value=" -Cervical CA screening"][/conditional][conditional field="USPSTFg6" condition="(USPSTFg6).is(' -Cervical CA screening')"] - [checkbox value="patient declined/deferred|patient uptodate for screening|patient requested|PAP performed, obtained sample and sent to lab|separate appointment arranged|not indicated for patient at this time"]
[/conditional][conditional field="wellvisitAPage|wellvisitAPgender" condition="((wellvisitAPage).isGreaterOrEqual('50')&&(wellvisitAPage).isLessOrEqual('79'))&&((wellvisitAPgender).is('F'))"][checkbox memo="F 50-79yo" memo_size="small" memo_color="yellow" name="USPSTFg5" value=" -Breast CA screening with imaging"][/conditional][conditional field="USPSTFg5" condition="(USPSTFg5).is(' -Breast CA screening with imaging')"] - [checkbox value="patient declined|patient requested|ordered|not indicated for patient at this time"]
[/conditional][conditional field="wellvisitAPgender" condition="(wellvisitAPgender).is('F')"][checkbox name="USPSTFg3" value=" -BRCA risks assessment tool"][/conditional][conditional field="USPSTFg3" condition="(USPSTFg3).is(' -BRCA risks assessment tool')"] - per risk tool [checkbox value="risk lower than average|risk average|risk above average"]
[/conditional][conditional field="wellvisitAPgender" condition="(wellvisitAPgender).is('F')"][checkbox name="USPSTFg4" value=" -Breast CA primary prevention with medication"][/conditional][conditional field="USPSTFg4" condition="(USPSTFg4).is(' -Breast CA primary prevention with medication')"] - [checkbox value="patient declined|patient accepted/agreed|ordered"]
[/conditional][conditional field="wellvisitAPage|wellvisitAPgender|wellvisitAPhighrisksex" condition="((wellvisitAPage).isGreaterOrEqual('12')&&(wellvisitAPage).isLessOrEqual('70'))&&((wellvisitAPgender).is('F'))&&((wellvisitAPhighrisksex).is('yes'))"][checkbox memo="F under 24yo or high risk behavior" memo_size="small" memo_color="yellow" name="USPSTFg7" value=" -GC and Chlamydia screening"][/conditional][conditional field="USPSTFg7" condition="(USPSTFg7).is(' -GC and Chlamydia screening')"] - [checkbox value="patient declined|patient requested|ordered|not indicated for patient at this time"]
[/conditional][conditional field="wellvisitAPage|wellvisitAPBMI" condition="((wellvisitAPage).isGreaterOrEqual('40')&&(wellvisitAPage).isLessOrEqual('70'))||((wellvisitAPBMI).is('overweight (25-30)')||(wellvisitAPBMI).is('obese (>30)'))"][checkbox memo="M/F 40-70yo or other risk factors" memo_size="small" memo_color="yellow" name="USPSTFg8" value=" -DM screening"][/conditional][conditional field="USPSTFg8" condition="(USPSTFg8).is(' -DM screening')"] with FPG/A1c - [checkbox value="patient declined|patient requested|ordered|not indicated for patient at this time"]
[/conditional][conditional field="wellvisitAPage" condition="(wellvisitAPage).isGreaterOrEqual('65')"][checkbox memo="M/F >65yo with increased risk(s)" memo_size="small" memo_color="yellow" name="USPSTFg9" value=" -Falls Prevention exercise interventions"][/conditional][conditional field="USPSTFg9" condition="(USPSTFg9).is(' -Falls Prevention exercise interventions')"] - [checkbox value="demonstrated|provided handout|not indicated for patient at this time"]
[/conditional][conditional field="wellvisitAPage|wellvisitAPgender" condition="((wellvisitAPage).isGreaterOrEqual('12')&&(wellvisitAPgender).is('F')"][checkbox memo="F of reproductive age and capability" memo_size="small" memo_color="yellow" name="USPSTFg10" value=" -Folic Acid supplementation of 0.4-0.8mg daily"][/conditional][conditional field="USPSTFg10" condition="(USPSTFg10).is(' -Folic Acid supplementation of 0.4-0.8mg daily')"] - [checkbox value="not indicated for this patient|provided information|patient agreed/accepted|ordered|gave info about OTC options|patient declined"]
[/conditional][checkbox memo="M/F overweight/obese or other CV risks" memo_size="small" memo_color="yellow" name="USPSTFg11" value=" -Healthy diet and physical activity counseling"][conditional field="USPSTFg11" condition="(USPSTFg11).is(' -Healthy diet and physical activity counseling')"] - [checkbox value="patient declined|patient agreed to discuss|discussed with specific mutually agreeable recommendations given|not indicated for patient at this time"]
[/conditional][conditional field="wellvisitAPage" condition="(wellvisitAPage).isGreaterOrEqual('55')"][checkbox memo="M/F born 1945-1965" memo_size="small" memo_color="yellow" name="USPSTFg12" value=" -Hepatitis C virus screening"][/conditional][conditional field="USPSTFg12" condition="(USPSTFg12).is(' -Hepatitis C virus screening')"] - [checkbox value="patient declined|patient requested|ordered|not indicated for patient at this time"]
[/conditional][conditional field="wellvisitAPhighrisksex" condition="(wellvisitAPhighrisksex).is('yes')"][checkbox memo="M/F at high risk of HIV acquisition" memo_size="small" memo_color="yellow" name="USPSTFg13" value=" -HIV PrEP"][checkbox name="HIVPrEPcriteria" memo="HIV high risk criteria for PrEP" memo_size="small" memo_color="yellow" value=""][/conditional][conditional field="HIVPrEPcriteria" condition="(HIVPrEPcriteria).is('')"][comment memo="(1) MSM & sexually active with 1+ of:
-sexual relationship with partner with HIV
-inconsistent use of condoms during receptive/insertive anal sex
-had STI with syphilis, GC, or Chlamydia within past 6 months
(2) F Heterosexual, sexually active with 1+ of:
-sexual relationship with partner with HIV
-inconsistent use of condoms with partner with unknown HIV status AND high risk for HIV (eg. injects drugs, MSM)
-had STI with syphilis or GC within past 6 months" memo_size="small" memo_color="orange"]
[/conditional][conditional field="USPSTFg13" condition="(USPSTFg13).is(' -HIV PrEP')"] - [checkbox value="patient declined|patient requested|ordered|not indicated for patient at this time"]
[/conditional][conditional field="wellvisitAPage" condition="(wellvisitAPage).isGreaterOrEqual('15')&&(wellvisitAPage).isLessOrEqual('65')"][checkbox memo="M/F 15-65yo at increased HIV risk" memo_size="small" memo_color="yellow" name="USPSTFg14" value=" -HIV screening"][/conditional][conditional field="USPSTFg14" condition="(USPSTFg14).is(' -HIV screening')"] - [comment memo="HIV high risk activities:
-MSM
-Injection drug use
-Anal sex without condoms
-Vaginal sex without condoms AND 1+ partner of unknown HIV status
-Exchanging sex for drugs/money
-Previous STIs or sex with partner with STI
-Sexual partner with HIV or partner at high risk for HIV
-Requesting testing for other STIs" memo_size="small" memo_color="orange"][checkbox value="low risk (no risk factors)|no testing ordered|risk factors present and testing recommended|patient agreed to testing|testing ordered|patient declined testing|patient requests testing"]
[/conditional][conditional field="wellvisitAPage|wellvisitAPtobacco" condition="((wellvisitAPage).isGreaterOrEqual('55')&&(wellvisitAPage).isLessOrEqual('80'))&&((wellvisitAPtobacco).is('current')||(wellvisitAPtobacco).is('former'))"][checkbox memo="M/F 55-80yo, 30 pack-year hx, current or quit 15yrs ago or less" memo_size="small" memo_color="yellow" name="USPSTFg15" value=" -Lung CA screening with Low-dose Lung CT"][/conditional][conditional field="USPSTFg15" condition="(USPSTFg15).is(' -Lung CA screening with Low-dose Lung CT')"] - [checkbox value="not indicated|patient declined|patient accepted/agreed|ordered"]
[/conditional][conditional field="wellvisitAPBMI" condition="(wellvisitAPBMI).is('obese (>30)')"][checkbox name="USPSTF16" memo="M/F, obese" memo_size="small" memo_color="yellow" value=" -Obesity counseling and multicomponent behavioral interventions"][/conditional][conditional field="USPSTF16" condition="(USPSTF16).is(' -Obesity counseling and multicomponent behavioral interventions')"] - reviewed BMI, [checkbox value="patient declined discussion|patient agreed/acknowledged|discussed multicomponent behavioral intervention options|provided patient handout|patient referre for multicomponent behavioral interventions"][comment memo="MCBIs are programs with group sessions 12+ in first year that-
  (1) help patients make healthy eating choices
  (2) encourage patients to increase physical activity
  (3) help patients monitor their own weight" memo_size="small" memo_color="yellow"]
[/conditional][conditional field="wellvisitAPage" condition="(wellvisitAPage).isLessOrEqual('24')"][checkbox name="USPSTF17" memo="M/F 24yo or younger with fair skin/high-risk skin type" memo_size="small" memo_color="yellow" value=" -Skin cancer behavioral counseling"][/conditional][conditional field="USPSTF17" condition="(USPSTF17).is(' -Skin cancer behavioral counseling')"] - [checkbox value="patient precontemplative|patient contemplative/accepted|provided education/handout"]
[/conditional][conditional field="wellvisitAPage|wellvisitAPgender|wellvisitAPmenopause" condition="((wellvisitAPage).isGreaterOrEqual('65')&&(wellvisitAPgender).is('F'))||((wellvisitAPgender).is('F')&&(wellvisitAPmenopause).is('postmenopausal'))"][checkbox memo="F >65yo or postmenopausal, or risk of major osteoporotic fracture greater or equal for >65yoF" memo_size="small" memo_color="yellow" name="USPSTFg18" value=" -Osteoporosis screening with BMD testing"][/conditional][conditional field="USPSTFg18" condition="(USPSTFg18).is(' -Osteoporosis screening with BMD testing')"] - [checkbox value="not indicated|patient declined|patient accepted/agreed|ordered"]
[/conditional][conditional field="wellvisitAPhighrisksex" condition="(wellvisitAPhighrisksex).is('yes')"][checkbox name="USPSTF19" memo="M/F adolescent/adult at increased risk for STI" memo_size="small" memo_color="yellow" value=" -STI counseling"][/conditional][conditional field="USPSTF19" condition="(USPSTF19).is(' -STI counseling')"] - provided information about [checkbox value="what STIs are|how STIs are transmitted|behaviors that increase risk of transmission|condom use|safe sex practices, problem solving, and goal setting"]
[/conditional][conditional field="wellvisitAPage" condition="(wellvisitAPage).isGreaterOrEqual('40')&&(wellvisitAPage).isLessOrEqual('75')"][checkbox name="USPSTF20" memo="M/F 40-75yo, 1+ CVD risk factors AND 10%+ CVD event risk" memo_size="small" memo_color="yellow" value=" -Statins for primary prevention of CVD"][/conditional][conditional field="USPSTF20" condition="(USPSTF20).is(' -Statins for primary prevention of CVD')"] - [checkbox value="not currently indicated for patient|patient agreed/accepted|patient declined|patient already taking|ordered|refilled"]
[/conditional][conditional field="wellvisitAPage" condition="(wellvisitAPage).isGreaterOrEqual('50')&&(wellvisitAPage).isLessOrEqual('59')"][checkbox memo="M/F 50-75yo" memo_size="small" memo_color="yellow" name="USPSTFg21" value=" -Colorectal cancer screening"][/conditional][conditional field="USPSTFg21" condition="(USPSTFg21).is(' -Colorectal cancer screening')"] - [checkbox value="patient uptodate|patient declined|patient accepted/agreed|referred for colonoscopy (q10yrs)|ordered FIT (annual)|referred/scheduled for flexible sigmoidoscopy (q10yrs) and FIT (annual)|ordered CT colonography (q5yrs)"]
[/conditional]-Discussed the following vaccinations based on CDC recommendations:
[comment memo="CDC Adult Immunization Schedule" memo_size="small" memo_color="blue"][checkbox memo="≥19yo" memo_size="small" name="VAC1" value=" -Influenza Vaccine, annually"][conditional field="VAC1" condition="(VAC1).is(' -Influenza Vaccine, annually')"] - [comment memo=" ≥19yo for inactivated (IIV) or recombinant (RIV); 19-49yo for live attenuated (LAIV)" memo_size="small" memo_color="yellow"][checkbox value="patient uptodate|patient declined & will continue to address each visit|patient to receive at todays visit"]
[/conditional][checkbox memo="≥19yo, either Tdap or Td acceptable, ensure ≥1 Tdap" memo_size="small" name="VAC2" value=" -Tdap/Td q10yrs"][conditional field="VAC2" condition="(VAC2).is(' -Tdap/Td q10yrs')"] - [checkbox value="patient uptodate|patient declined & will continue to address each visit|patient accepted|Td to be given at today's visit|Tdap to be given at today's visit"]
[/conditional][conditional field="wellvisitAPage" condition="(wellvisitAPage).isGreaterOrEqual('18')&&(wellvisitAPage).isLessOrEqual('64')"][checkbox memo="19-64yo, 1 dose for all; for healthcare workers 2 doses ≥4wks apart" memo_size="small" name="VAC3" value=" -Measles/Mumps/Rubella Vaccine"][/conditional][conditional field="VAC3" condition="(VAC3).is(' -Measles/Mumps/Rubella Vaccine')"] - [checkbox value="patient uptodate|patient declined & will continue to address each visit|patient to receive at todays visit"]
[/conditional][conditional field="wellvisitAPage" condition="(wellvisitAPage).isGreaterOrEqual('18')&&(wellvisitAPage).isLessOrEqual('49')"][checkbox memo="19-49yo" memo_size="small" name="VAC4" value=" -Varicella Vaccine"][/conditional][conditional field="VAC4" condition="(VAC4).is(' -Varicella Vaccine')"] - [checkbox memo="if no evidence of immunity or healthcare worker" memo_size="small" memo_color="yellow" value="2 doses 4-8wks apart"][checkbox memo="
↑ evidence of immunity: 
-U.S.-born before 1980 (except for pregnant women and health care personnel
-documentation of 2 doses varicella-containing vaccine at least 4 weeks apart
-diagnosis/verified hx of varicella or herpes zoster infection by a health care provider
-laboratory evidence of immunity or disease" memo_size="small" memo_color="yellow" value="evidence of immunity, no vaccination required"] [checkbox value="patient uptodate|patient declined & will continue to address each visit|patient to receive at todays visit"]
[/conditional][conditional field="wellvisitAPage" condition="(wellvisitAPage).isGreaterOrEqual('50')"][checkbox memo="≥50yo" memo_size="small" name="VAC5" value=" -Zoster/Shingles Vaccine"][/conditional][conditional field="VAC5" condition="(VAC5).is(' -Zoster/Shingles Vaccine')"] - [checkbox memo="preferred, ≥50yo" memo_size="small" memo_color="yellow" value="Zoster recombinant (Shingrix) 2 doses 2-6mos apart (≥4wks min)"][checkbox memo="if Shingrix not feasible, 60-65yo" memo_size="small" memo_color="yellow" value="Zoster live (Zostavax) 1 dose"] [checkbox value="patient uptodate|patient declined & will continue to address each visit|patient to receive at todays visit"]
[/conditional][conditional field="wellvisitAPage" condition="(wellvisitAPage).isLessOrEqual('45')"][checkbox memo="≤26yo recommended, 27-45yo with shared decision making" memo_size="small" name="VAC6" value=" -HPV Vaccine"][/conditional][conditional field="VAC6" condition="(VAC6).is(' -HPV Vaccine')"] - [checkbox memo="if ≥15yo at initial vaccination" memo_size="small" memo_color="yellow" value="3 doses at 0,1,6mo interval (≥4wks #1-#2, ≥12wks #2-#3, ≥5mo #1-#3)"][checkbox memo="if 9-14yo at initial vaccination and had 1 or 2 doses less than 5mo apart" memo_size="small" memo_color="yellow" value="1 dose"][checkbox memo="if 9-14yo at initial vaccination and had 2 doses ≥5mo apart" memo_size="small" memo_color="yellow" value="series complete"] [checkbox value="patient uptodate|patient declined & will continue to address each visit|patient to receive at todays visit"]
[/conditional][checkbox memo="≥65yo or 19-64yo with specific conditions" memo_size="small" name="VAC7" value=" -Pneumococcal Vaccine"][conditional field="VAC7" condition="(VAC7).is(' -Pneumococcal Vaccine')"] - [checkbox memo="↑ ≥65yo without risk factors -or-
≤64yo with chronic heart/lung/liver disease, diabetes, alcoholism, cigarette smoking" memo_size="small" memo_color="yellow" value="PPSV23 1 dose (recommended)|also PCV13 1 dose (with shared decision making, will give PCV13 + PPSV23 ≥1yr later)"] [checkbox memo="
↑ ≥19yo with CSF leak or cochlear implants or immunocompromised by:
-congenital or acquired immunodeficiency (ie. B/T lymphocyte deficiency, complement deficiencies, phagocytic disorders, HIV infection)
-chronic renal failure, nephrotic syndrome
-leukemia, lymphoma, Hodgkin disease, generalized malignancy
-iatrogenic immunosuppression (ie. drug or radiation therapy)
-solid organ transplant
-multiple myeloma
-anatomical or functional asplenia (including sickle cell disease and other hemoglobinopathies)" memo_size="small" memo_color="yellow" value="1 dose PCV13 + PPSV23 #1 ≥8 wks later + PPSV23 #2 ≥5yrs later"] [checkbox value="patient uptodate|patient declined & will continue to address each visit|patient to receive at todays visit"]
[/conditional][checkbox memo="≥19yo if desires or at risk" memo_size="small" name="VAC8" value=" -Hep A Vaccine"][conditional field="VAC8" condition="(VAC8).is(' -Hep A Vaccine')"] - [comment memo="Hep A risk factors:
-Chronic liver disease  (e.g., persons with hepatitis B, hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, ALT or AST level greater than twice the upper limit of normal)
-HIV infection
-Men who have sex with men
-Injection or noninjection drug use
-Persons experiencing homelessness
-Work with hepatitis A virus in research laboratory or with nonhuman primates with hepatitis A virus infection
-Travel in countries with high or intermediate endemic hepatitis A
-Close, personal contact with international adoptee (e.g., household or regular babysitting) in first 60 days after arrival from country with high or intermediate endemic hepatitis A (administer dose 1 as soon as adoption is planned, at least 2 weeks before adoptee’s arrival)
-Pregnancy if at risk for infection or severe outcome from infection during pregnancy
-Settings for exposure, including health care settings targeting services to injection or noninjection drug users or group homes and nonresidential day care facilities for developmentally disabled persons" memo_size="small" memo_color="orange"][checkbox memo="Havrix 6-12mo apart, Vaqta 6-18mo apart" memo_size="small" memo_color="yellow" value="2 dose series (Havrix/Vaqta)"][checkbox memo="≥4wks #1-#2, ≥5mo #2-#3" memo_size="small" memo_color="yellow" value="HepA/HepB (Twinrix) 3 doses"] [checkbox value="patient uptodate|patient declined & will continue to address each visit|patient to receive at todays visit"]
[/conditional][checkbox memo="≥19yo if desires or at risk" memo_size="small" name="VAC9" value=" -Hep B Vaccine"][conditional field="VAC9" condition="(VAC9).is(' -Hep B Vaccine')"] - [comment memo="Hep B risk factors:
-Chronic liver disease (e.g., persons with hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, ALT or AST level greater than twice upper limit of normal)
-HIV infection
-Sexual exposure risk (e.g., sex partners of HBsAg-positive persons; sexually active persons not in mutually monogamous relationships; persons seeking evaluation or treatment for a sexually transmitted infection; men who have sex with men)
-Current or recent injection drug use
-Percutaneous or mucosal risk for exposure to blood (e.g., household contacts of HBsAg-positive persons; residents and staff of facilities for developmentally disabled persons; health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids; hemodialysis, peritoneal dialysis, home dialysis, and predialysis patients; persons with diabetes mellitus age younger than 60 years and, at discretion of treating clinician, those age 60 years or older)
-Incarcerated persons
-Travel in countries with high or intermediate endemic hepatitis B
-Pregnancy if at risk for infection or severe outcome from infection during pregnancy. Heplisav-B not currently recommended due to lack of safety data in pregnant women" memo_size="small" memo_color="orange"][checkbox memo="≥4wks apart" memo_size="small" memo_color="yellow" value="Heplisav-B 2 dose series "][checkbox memo="0,1,6mo (≥4wks #1-#2, ≥8wks #2-#3, ≥16wks #1-#3)" memo_size="small" memo_color="yellow" value="Engerix-B or Recombivax HB 3 dose series"][checkbox memo="≥4wks #1-#2, ≥5mo #2-#3" memo_size="small" memo_color="yellow" value="HepA/HepB (Twinrix) 3 doses"] [checkbox value="patient uptodate|patient declined & will continue to address each visit|patient to receive at todays visit"]
[/conditional][checkbox memo="≥19yo with certain conditions" memo_size="small" name="VAC10" value=" -Meningococcal Vaccine"][conditional field="VAC10" condition="(VAC10).is(' -Meningococcal Vaccine')"] - [checkbox memo="
↑ First-year college students who live in residential housing (if not previously vaccinated at age 16 years or older) and military recruits" memo_size="small" memo_color="yellow" value="MenACWY (Menactra/Menveo) 1 dose "][checkbox memo="
↑ Travel in countries with hyperendemic or epidemic meningococcal disease, microbiologists routinely exposed to Neisseria meningitidis" memo_size="small" memo_color="yellow" value="MenACWY (Menactra/Menveo) 1 dose initially and q5yrs (if risk remains)"][checkbox memo="
↑ Anatomical or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use" memo_size="small" memo_color="yellow" value="MenACWY (Menactra/Menveo) 2 dose series ≥8wks apart and q5yrs (if risk remains)"] [checkbox memo="↑ special situations:
-Anatomical or functional asplenia (including sickle cell disease), persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use
-Microbiologists routinely exposed to Neisseria meningitidis" memo_size="small" memo_color="yellow" value="MenB-4C (Baxsero) 2 dose series (≥1mo apart), booster in 1yr then q2-3yrs|MenB-FHbp (Trumenba) 3 dose (0,1-2mo,6mo) or 2 dose (≥6mo apart) series, booster in 1yr then q2-3yrs"] [checkbox value="patient uptodate|patient declined & will continue to address each visit|patient to receive at todays visit"]
[/conditional][checkbox memo="≥19yo with certain conditions" memo_size="small" name="VAC11" value=" -HIB type B Vaccine"][conditional field="VAC11" condition="(VAC11).is(' -HIB type B Vaccine')"] - [checkbox memo="
↑ anatomic/functional asplenia" memo_size="small" memo_color="yellow" value="HIB-B 1 dose (preferably 14d prior to elective splenectomy"][checkbox memo="↑ hematopoietic stem cell transplant" memo_size="small" memo_color="yellow" value="HIB-B 3 dose series (each ≥4wks apart) 6-12mo after successful transplant (regardless of prior HIB vacc)"] [checkbox value="patient uptodate|patient declined & will continue to address each visit|patient to receive at todays visit"]
[/conditional][conditional field="apCONTRACEP" condition="(apCONTRACEP).is('#CONTRACEPTIVE MANAGEMENT:')"]
[/conditional][conditional field="wellvisitAPage|wellvisitAPgender|wellvisitAPmenopause" condition="((wellvisitAPage).isLessOrEqual('64')&&(wellvisitAPgender).is('F')&&(wellvisitAPmenopause).is('premenopausal'))"][checkbox name="apCONTRACEP" value="#CONTRACEPTIVE MANAGEMENT:"][/conditional][conditional field="apCONTRACEP" condition="(apCONTRACEP).is('#CONTRACEPTIVE MANAGEMENT:')"]
-Discussed these methods to include contraindications, indications, and possible side effects: [checkbox value="oral combination estrogen/progesterone pills|oral progesterone only pills|hormone-releasing IUD|Copper IUD|progesterone IM injections|Nuvaring|Transdermal patches|Nexplanon|periodic abstinence|barrier methods (condom and diaphragm in combination with spermicidal lubrication)|withdrawal methods|permanent sterilization methods (tubal ligation, vasectomy, and essure)|abstinence|birth control while breastfeeding and lactation amenorrhea"].
-Patient appears a reasonable candidate for these indication(s): [checkbox value="prevention of pregnancy|regulating irregular menstrual cycles|dysmenorrhea|menorrhagia|acne|other-"] [text size="50"]
-Discussed relative risks/benefits of each, and relative/absolute contraindications of each.
-Patient opted for: [select value="oral combination estrogen/progesterone pills|progesterone only pills|progesterone IM injections q3mo|Nexplanon|Mirena|Skyla|Paragard|condoms|vasectomy for partner|tubal ligation|no contraception|natural family planning"].
[checkbox memo="Criteria for not requiring HCG test" memo_size="small" name="HCGtestingMDM" value="-HCG testing MDM: CDC criteria checklist"][/conditional][conditional field="HCGtestingMDM" condition="(HCGtestingMDM).is('-HCG testing MDM: CDC criteria checklist')"]
[checklist name="variable_1" value="Is less than or equal to 7 days after the start of normal menses=1|Has not had sexual intercourse since the start of last normal menses=1|Has been correctly and consistently using a reliable method of contraception=1|Is less than or equal to 7 days after spontaneous or induced abortion=1|Is within 4 weeks postpartum=1|Is fully or nearly fully breastfeeding (exclusively breastfeeding or the vast majority - more than 85 percent - of feeds are breastfeeds), amenorrheic, and less than 6 months postpartum=1"]--Score --> [calc memo="number" value="score=(variable_1)"] out of 6 items
--Interpretation --> [calc memo="result" value="score2=(variable_1);score2>0?'Testing optional - Can be reasonably certain that patient is not pregnant without a pregnancy test':'Testing recommended - Cannot be reasonably certain that patient is not pregnant without a pregnancy test'"]
[/conditional][conditional field="apCONTRACEP" condition="(apCONTRACEP).is('#CONTRACEPTIVE MANAGEMENT:')"]-HCG testing decision: [select value="no HCG testing indicated & not performed|will test HCG and verify negative result prior to patient starting contraceptive method|HCG testing done and results negative"]
-Next action(s): [checkbox value="Meds prescribed and patient to pickup in pharmacy. "][checkbox value="Applicable procedure performed same visit - see procedure note. "][checkbox value="Patient will be scheduled for applicable procedure. "][checkbox value="Patient referred to procedures clinic for scheduling of applicable procedure. "][checkbox value="Patient to get Depo-Provera today. |Patient to get Depo-Provera at future date with appropriate screening/testing done. "][checkbox name="contracepDEPO" value="Gave Medroxyprogesterone 150mg IM injection."]
[/conditional][conditional field="contracepDEPO" condition="(contracepDEPO).is('Gave Medroxyprogesterone 150mg IM injection.')"] -Patient verbally consented
 -[select value="R|L"] [select value="Deltoid|Glut muscle"]
 -Lot# [text size="10"], Exp Date [text size="10"]
 -Next window [select memo="month" memo_size="small" value="Jan|Feb|Mar|Apr|May|Jun|Jul|Aug|Sep|Oct|Nov|Dec"] [text memo="day" memo_size="small" size="4"] THRU [select memo="month" memo_size="small" value="Jan|Feb|Mar|Apr|May|Jun|Jul|Aug|Sep|Oct|Nov|Dec"] [text memo="day" memo_size="small" size="4"] [text memo="year" memo_size="small" size="8"]
 -Observed for 5 minutes following injection
 -No immediate complications noted
 -Left in stable condition
[/conditional]
Additional issues discovered/addressed: [textarea default="none" rows="3"]

DISPOSITION
-Followup: [text size="5"] [select value="|routine f/u visit not indicated|day(s)|week(s)|month(s)"] [checkbox value="with PCM|with unit provider"][text memo="f/u free text" memo_size="small" size="60"]
-Explained the above assessment and plan to patient who: [select value="|acknowledged understanding and intent to follow through with plan|desires second opinion"][comment memo="
coding blurbs" memo_size="small" memo_color="blue"][checkbox value="-The above SocHx/Allergies/Meds/PMHx/PSHx/FMHx were reviewed & updated at today's visit.
"][checkbox value="-The scribe/medic/nurse/student assisted in collecting and documenting the patient's history.
-I have personally reviewed it and verified its accuracy.
"][checkbox value="-The scribe/medic/nurse/student assisted in documenting the physical exam performed by me.
-I have personally reviewed it and verified its accuracy.
"][checkbox value="-Laboratory results as displayed were reviewed and interpreted
"][checkbox value="-Radiologic study results as displayed were reviewed and interpreted
"][checkbox value="-Radiologic study images which results are displayed in note were reviewed and interpreted
"][checkbox value="-Pap smear was performed and sample collected at today's visit, sample to be sent to lab for analysis
"][conditional field="APvirtualblurb" condition="(APvirtualblurb).is('Virtual Encounter Statement')"]
[/conditional][checkbox name="APvirtualblurb" memo="*" memo_color="blue" memo_size="small" value="Virtual Encounter Statement"]
[conditional field="APvirtualblurb" condition="(APvirtualblurb).is('Virtual Encounter Statement')"] - Spent [text size="5"] minutes via [select value="realtime audio/video communication|voice-only/telephone|asynchronous secure text messaging"] involving obtaining/reviewing history, [checkbox value="conducting visual exam|discussing test results|discussing workup|discussing above plan|patient education"]
[/conditional]