Medication
[checkbox memo="Weight" name="Wt-Dose" value="" memo_color="blue"][conditional field="Wt-Dose" condition="(Wt-Dose).is('')"]Dosing Wt: [text name="kg" size="4"] kgs[/conditional][checkbox memo="Blank Drug" name="Blank" memo_color="yellow" value=""][conditional field="Blank" condition="(Blank).is('')"] --[text name="med_1" size="15"] ([text name="med_strength_1" size="5"] [select name="med_unitstrength_1" value="mg|mcg|G"]), Take [text name="med_dose_1" size="5"] [select name="med_unit_1" value="tab(s)|mL|capsule(s)|drop(s)|spray(s)|puff(s)|app(s)|neb"], [select name="med_freq_1" value="Daily|HS|BID|TID|QID|every 3 hours|every 4 hours|every 6 hours"] for [text name=" med_dur_1" default="30" size="2"]days, disp: [text name="med_disp_1" size="4"] [var name="med_unit_1" name="unit"], refill(s) [select name="med_refill_1" value="0|1|2|3|4|5|6"][/conditional][checkbox memo="Blank Drug" name="Blank_2" memo_color="yellow" value=""][conditional field="Blank_2" condition="(Blank_2).is('')"] --[text name="med_2" size="15"] ([text name="med_strength_2" size="5"] [select name="med_unitstrength_2" value="mg|mcg|G"]), Take [text name="med_dose_2" size="5"] [select name="med_unit_2" value="tab(s)|mL|capsule(s)|drop(s)|spray(s)|puff(s)|app(s)|neb"], [select name="med_freq_2" value="Daily|HS|BID|TID|QID|every 3 hours|every 4 hours|every 6 hours"] for [text name=" med_dur_2" default="30" size="2"]days, disp: [text name="med_disp_2" size="4"] [var name="med_unit_2" name="unit"], refill(s) [select name="med_refill_2" value="0|1|2|3|4|5|6"][/conditional][checkbox memo="Blank Drug" memo_color="yellow" name="Blank_3" value=""][conditional field="Blank_3" condition="(Blank_3).is('')"] --[text name="med_3" size="15"] ([text name="med_strength_3" size="5"] [select name="med_unitstrength_3" value="mg|mcg|G"]), Take [text name="med_dose_3" size="5"] [select name="med_unit_3" value="tab(s)|mL|capsule(s)|drop(s)|spray(s)|puff(s)|app(s)|neb"], [select name="med_freq_3" value="Daily|HS|BID|TID|QID|every 3 hours|every 4 hours|every 6 hours"] for [text name=" med_dur_3" default="30" size="2"]days, disp: [text name="med_disp_3" size="4"] [var name="med_unit_3" name="unit"], refill(s) [select name="med_refill_3" value="0|1|2|3|4|5|6"][/conditional][checkbox memo="Blank Drug" name="Blank_4" memo_color="yellow" value=""][conditional field="Blank_4" condition="(Blank_4).is('')"] --[text name="med_4" size="15"] ([text name="med_strength_4" size="5"] [select name="med_unitstrength_4" value="mg|mcg|G"]), Take [text name="med_dose_4" size="5"] [select name="med_unit_4" value="tab(s)|mL|capsule(s)|drop(s)|spray(s)|puff(s)|app(s)|neb"], [select name="med_freq_4" value="Daily|HS|BID|TID|QID|every 3 hours|every 4 hours|every 6 hours"] for [text name=" med_dur_4" default="30" size="2"]days, disp: [text name="med_disp_4" size="4"] [var name="med_unit_4" name="unit"], refill(s) [select name="med_refill_4" value="0|1|2|3|4|5|6"][/conditional] [checkbox memo="Blank Drug" memo_color="yellow" name="Blank_5" value=""][conditional field="Blank_5" condition="(Blank_5).is('')"] --[text name="med_5" size="15"] ([text name="med_strength_5" size="5"] [select name="med_unitstrength_5" value="mg|mcg|G"]), Take [text name="med_dose_5" size="5"] [select name="med_unit_5" value="tab(s)|mL|capsule(s)|drop(s)|spray(s)|puff(s)|app(s)|neb"], [select name="med_freq_5" value="Daily|HS|BID|TID|QID|every 3 hours|every 4 hours|every 6 hours"] for [text name=" med_dur_5" default="30" size="2"]days, disp: [text name="med_disp_5" size="4"] [var name="med_unit_5" name="unit"], refill(s) [select name="med_refill_5" value="0|1|2|3|4|5|6"][/conditional] [checkbox memo="Blank PRN Drug" memo_color="yellow" name="Blank_PRN_1" value=""][conditional field="Blank_PRN_1" condition="(Blank_PRN_1).is('')"] --[text name="med_PRN_1" size="15"] ([text name="med_strength_PRN_1" size="5"] [select name="med_unitstrength_PRN_1" value="mg|mcg|G"]), Take [text name="med_dose_PRN_1" size="5"] [select name="med_unit_PRN_1" value="tab(s)|mL|capsule(s)|drop(s)|spray(s)|puff(s)|app(s)|neb"] as needed every [select name="med_freq_PRN_1" value="2 hours|3 hours|4 hours|6 hours|day"] for [text name=" med_reason_PRN_1" default="" size="10"], disp: [text name="med_disp_PRN_1" size="4"] [var name="med_unit_PRN_1" name="unit"], refill(s) [select name="med_refill_PRN_1" value="0|1|2|3|4|5|6"][/conditional] [checkbox memo="Blank PRN Drug" memo_color="yellow" name="Blank_PRN_2" value=""][conditional field="Blank_PRN_2" condition="(Blank_PRN_2).is('')"] --[text name="med_PRN_2" size="15"] ([text name="med_strength_PRN_2" size="5"] [select name="med_unitstrength_PRN_2" value="mg|mcg|G"]), Take [text name="med_dose_PRN_2" size="5"] [select name="med_unit_PRN_2" value="tab(s)|mL|capsule(s)|drop(s)|spray(s)|puff(s)|app(s)|neb"] as needed every [select name="med_freq_PRN_2" value="2 hours|3 hours|4 hours|6 hours|day"] for [text name=" med_reason_PRN_2" default="" size="10"], disp: [text name="med_disp_PRN_2" size="4"] [var name="med_unit_PRN_2" name="unit"], refill(s) [select name="med_refill_PRN_2" value="0|1|2|3|4|5|6"][/conditional][checkbox memo="Acetaminophen (160mg/5mL) (Ped)" name="Acet" value=""][conditional field="Acet" condition="(Acet).is('')"] --Acetaminophen (160 mg/5 mL) (Ped), [text name="Acet_dose" default="15" memo="10-15" size="3"] mg/kg ([calc memo="dose" value="acetaminophen=(kg)*(Acet_dose)"] mg/dose), Take [calc memo="mL" value="score1=((acetaminophen)*(5/160)).toFixed(1)"] mL by mouth every 6 hours as needed for pain/discomfort/temp >100.4F[/conditional][checkbox memo="Abilify (10 mg)" name="Abil_2565" value=""][conditional field="Abil_2565" condition="(Abil_2565).is('')"] [text default="--Abilify (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Accupril (Quinapril) (10 mg)" name="Accu_5271" value=""][conditional field="Accu_5271" condition="(Accu_5271).is('')"] [text default="--Accupril (Quinapril) (10 mg), 1 tab PO BID, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Actonel (35 mg)" name="Acto_6976" value=""][conditional field="Acto_6976" condition="(Acto_6976).is('')"] [text default="--Actonel (35 mg), 1 tab PO weekly, Disp: 4, RF: 3" size="80"][/conditional][checkbox memo="Actos (Pioglitazone) (15 mg)" name="Acto_739" value=""][conditional field="Acto_739" condition="(Acto_739).is('')"] [text default="--Actos (Pioglitazone) (15 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Actos (Pioglitazone) (30 mg)" name="Acto_2745" value=""][conditional field="Acto_2745" condition="(Acto_2745).is('')"] [text default="--Actos (Pioglitazone) (30 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Adderall XR (Amphetamine Salt XR) (10 mg)" name="Adde_7732" value=""][conditional field="Adde_7732" condition="(Adde_7732).is('')"] [text default="--Adderall XR (Amphetamine Salt XR) (10 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Advair Diskus (250 mcg/50 mcg)" name="Adva_281" value=""][conditional field="Adva_281" condition="(Adva_281).is('')"] [text default="--Advair Diskus (250 mcg/50 mcg), 1 puff INH daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Allegra (Fexofenadine) (180 mg)" name="Alle_116" value=""][conditional field="Alle_116" condition="(Alle_116).is('')"] [text default="--Allegra (Fexofenadine) (180 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Altace (Ramipril) (5 mg)" name="Alta_6920" value=""][conditional field="Alta_6920" condition="(Alta_6920).is('')"] [text default="--Altace (Ramipril) (5 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Amaryl (Glimepiride) (2 mg)" name="Amar_4447" value=""][conditional field="Amar_4447" condition="(Amar_4447).is('')"] [text default="--Amaryl (Glimepiride) (2 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Ambien (Zolpidem) (10 mg)" name="Ambi_1167" value=""][conditional field="Ambi_1167" condition="(Ambi_1167).is('')"] [text default="--Ambien (Zolpidem) (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Ambien CR (Zolpidem CR) (12.5 mg)" name="Ambi_6983" value=""][conditional field="Ambi_6983" condition="(Ambi_6983).is('')"] [text default="--Ambien CR (Zolpidem CR) (12.5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Amoxycillin (Q8H) (Ped)" name="Amox" value=""][conditional field="Amox" condition="(Amox).is('')"] --Amoxycillin (250mg/5mL), [text name="Amox_dose" default="25" memo="25-60" size="2"] mg/kg ([calc memo="dose" value="Amox_dose2=(kg)*(Amox_dose)"] mg), Take [calc memo="mL" value="Amox_mL=((Amox_dose2)*(5/250)).toFixed(1)"] mL every 8 hours for [text name="Amox_dur" default="10" size="2"] days, disp: [calc value="Amox_disp=(Amox_mL)*8*(Amox_dur)"] mL, refill: 0[/conditional][checkbox memo="Amoxil (Amoxicillin) (500 mg)" name="Amox_138" value=""][conditional field="Amox_138" condition="(Amox_138).is('')"] [text default="--Amoxil (Amoxicillin) (500 mg), 1 cap PO BID for 10 days, Disp: 20, RF: 3" size="80"][/conditional][checkbox memo="Aricept (Donepezil) (5 mg)" name="Aric_9131" value=""][conditional field="Aric_9131" condition="(Aric_9131).is('')"] [text default="--Aricept (Donepezil) (5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Augmentin (Q12H) (Ped 3+ months)" name="Augm" value=""][conditional field="Augm" condition="(Augm).is('')"] --Augmentin (200mg/5mL), [text name="Augm_dose" default="45" memo="" size="2"] mg/kg/day ([calc memo="dose" value="Augm_dose2=((kg)*(Augm_dose))/2"] mg/dose), Take [calc memo="mL" value="Augm_mL=((Augm_dose2)*(5/200)).toFixed(1)"] mL every 12 hours for [text name="Augm_dur" default="10" size="2"] days[/conditional][checkbox memo="Augmentin (Amox Tr-K Clv) (875 mg)" name="Augm_7205" value=""][conditional field="Augm_7205" condition="(Augm_7205).is('')"] [text default="--Augmentin (Amox Tr-K Clv) (875 mg), 1 tab PO BID for 10 days, Disp: 20, RF: 0" size="80"][/conditional][checkbox memo="Avapro (150 mg)" name="Avap_5047" value=""][conditional field="Avap_5047" condition="(Avap_5047).is('')"] [text default="--Avapro (150 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Avelox (400 mg)" name="Avel_3046" value=""][conditional field="Avel_3046" condition="(Avel_3046).is('')"] [text default="--Avelox (400 mg), 1 tab PO daily for 7 days, Disp: 7, RF: 0" size="80"][/conditional][checkbox memo="Azithromycin (Ped)" name="Azith" value=""][conditional field="Azith" condition="(Azith).is('')"] --Azithromycin (200mg/5mL), [text name="Azith_dose" default="5" memo="" size="2"] mg/kg ([calc memo="dose" value="Azith_dose2=(kg)*(Azith_dose)"] mg), Take [calc memo="mL" value="Azith_mL_1=(((Azith_dose2)*(5/200))*2).toFixed(1)"] mL on day 1, and [calc memo="mL" value="Azith_mL_2=((Azith_dose2)*(5/200)).toFixed(1)"] mL on days 2-5[/conditional][checkbox memo="Azithromycin (Adult)" name="Azith_adult" value=""][conditional field="Azith_adult" condition="(Azith_adult).is('')"] --Azithromycin (250 mg) take 2 tab by mouth on day 1, then 1 tab once daily for 4 days [/conditional][checkbox memo="Bactrim (Sulfameth/Trimeth)" name="Bact_538" value=""][conditional field="Bact_538" condition="(Bact_538).is('')"] [text default="--Bactrim (Sulfameth/Trimeth), 1 tab PO BID for 10 days, Disp: 20, RF: 0" size="80"][/conditional][checkbox memo="Bactroban (Mupirocin)" name="Bact_3913" value=""][conditional field="Bact_3913" condition="(Bact_3913).is('')"] [text default="--Bactroban (Mupirocin), 1 app TOP daily, Disp: 1 Tube, RF: 0" size="80"][/conditional][checkbox memo="Benicar (20 mg)" name="Beni_3836" value=""][conditional field="Beni_3836" condition="(Beni_3836).is('')"] [text default="--Benicar (20 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Boric Acid (Vaginal)" name="Bor" value=""][conditional field="Bor" condition="(Bor).is('')"] --Boric Acid Suppository (1 Supp), PV, HS for 7 days, disp: 7, refill(s) 0[/conditional][checkbox memo="Boniva (150 mg)" name="Boni_2454" value=""][conditional field="Boni_2454" condition="(Boni_2454).is('')"] [text default="--Boniva (150 mg), 1 tab PO Monthly, Disp: 1, RF: 3" size="80"][/conditional][checkbox memo="Catapres (Clonidine) (0.1 mg)" name="Cata_6671" value=""][conditional field="Cata_6671" condition="(Cata_6671).is('')"] [text default="--Catapres (Clonidine) (0.1 mg), 1 tab PO TID, Disp: 90, RF: 3" size="80"][/conditional][checkbox memo="Celebrex (200 mg)" name="Cele_302" value=""][conditional field="Cele_302" condition="(Cele_302).is('')"] [text default="--Celebrex (200 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Celexa (Citalopram) (20 mg)" name="Cele_1745" value=""][conditional field="Cele_1745" condition="(Cele_1745).is('')"] [text default="--Celexa (Citalopram) (20 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Chantix (1 mg)" name="Chan_7799" value=""][conditional field="Chan_7799" condition="(Chan_7799).is('')"] [text default="--Chantix (1 mg), 1 tab PO daily, Disp: 56, RF: 1, 0.5 mg PO once daily on Days 1 through 3, then 0.5 mg PO twice daily on Days 4 through 7, and finally 1 mg PO twice daily on day 8 until the end of treatment" size="80"][/conditional][checkbox memo="Cialis (5 mg)" name="Cial_9622" value=""][conditional field="Cial_9622" condition="(Cial_9622).is('')"] [text default="--Cialis (5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Cipro (Ciprofloxacin) (500 mg)" name="Cipr_8618" value=""][conditional field="Cipr_8618" condition="(Cipr_8618).is('')"] [text default="--Cipro (Ciprofloxacin) (500 mg), 1 tab PO BID for 10 days, Disp: 20, RF: 0" size="80"][/conditional][checkbox memo="Combivent (ipratropium bromide/albuterol) (20 mcg-100 mcg)" name="Comb_9414" value=""][conditional field="Comb_9414" condition="(Comb_9414).is('')"] [text default="--Combivent (ipratropium bromide/albuterol) (20 mcg-100 mcg), 1 puff INH daily, Disp: 1 MDI, RF: 3" size="80"][/conditional][checkbox memo="Coreg (Carvedilol) (6.25 mg)" name="Core_4856" value=""][conditional field="Core_4856" condition="(Core_4856).is('')"] [text default="--Coreg (Carvedilol) (6.25 mg), 1 tab PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Coumadin (Warfarin) (5 mg)" name="Coum_4630" value=""][conditional field="Coum_4630" condition="(Coum_4630).is('')"] [text default="--Coumadin (Warfarin) (5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Cozaar (Losartan) (50 mg)" name="Coza_5377" value=""][conditional field="Coza_5377" condition="(Coza_5377).is('')"] [text default="--Cozaar (Losartan) (50 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Crestor (10 mg)" name="Cres_9611" value=""][conditional field="Cres_9611" condition="(Cres_9611).is('')"] [text default="--Crestor (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Cymbalta (30 mg)" name="Cymb_3069" value=""][conditional field="Cymb_3069" condition="(Cymb_3069).is('')"] [text default="--Cymbalta (30 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Depakote (Divalproex) (500 mg)" name="Depa_9580" value=""][conditional field="Depa_9580" condition="(Depa_9580).is('')"] [text default="--Depakote (Divalproex) (500 mg), 1 tab PO TID, Disp: 90, RF: 3" size="80"][/conditional][checkbox memo="Desyrel (Trazodone) (50 mg)" name="Desy_880" value=""][conditional field="Desy_880" condition="(Desy_880).is('')"] [text default="--Desyrel (Trazodone) (50 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Diflucan (Fluconazole) (400 mg)" name="Difl_299" value=""][conditional field="Difl_299" condition="(Difl_299).is('')"] [text default="--Diflucan (Fluconazole) (400 mg), 1 tab PO for 10 days, Disp: 10, RF: 0" size="80"][/conditional][checkbox memo="Dilantin (Phenytoin) (100 mg)" name="Dila_3162" value=""][conditional field="Dila_3162" condition="(Dila_3162).is('')"] [text default="--Dilantin (Phenytoin) (100 mg), 1 cap PO daily, Disp: 90, RF: 3" size="80"][/conditional][checkbox memo="Diovan (80 mg)" name="Diov_2362" value=""][conditional field="Diov_2362" condition="(Diov_2362).is('')"] [text default="--Diovan (80 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Effexor XR (Venlafaxine XR) (75 mg)" name="Effe_3062" value=""][conditional field="Effe_3062" condition="(Effe_3062).is('')"] [text default="--Effexor XR (Venlafaxine XR) (75 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Evista (60 mg)" name="Evis_3167" value=""][conditional field="Evis_3167" condition="(Evis_3167).is('')"] [text default="--Evista (60 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Flagyl (Metronidazole) (500 mg)" name="Flag_8700" value=""][conditional field="Flag_8700" condition="(Flag_8700).is('')"] [text default="--Flagyl (Metronidazole) (500 mg), 1 tab PO BID for 10 days, Disp: 20, RF: 0" size="80"][/conditional][checkbox memo="Flexeril (Cyclobenzaprine) (10 mg)" name="Flex_6049" value=""][conditional field="Flex_6049" condition="(Flex_6049).is('')"] [text default="--Flexeril (Cyclobenzaprine) (10 mg), 1 tab PO daily, Disp: 30, RF: 0" size="80"][/conditional][checkbox memo="Flexpen (Novolog 70-30)" name="Flex_709" value=""][conditional field="Flex_709" condition="(Flex_709).is('')"] [text default="--Flexpen (Novolog 70-30), 1 units SubQ daily, Disp: 1 vial, RF: 3" size="80"][/conditional][checkbox memo="Flomax (Tamsulosin) (0.4 mg)" name="Flom_8044" value=""][conditional field="Flom_8044" condition="(Flom_8044).is('')"] [text default="--Flomax (Tamsulosin) (0.4 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Flonase (Fluticasone) (50 mcg)" name="Flon_4663" value=""][conditional field="Flon_4663" condition="(Flon_4663).is('')"] [text default="--Flonase (Fluticasone) (50 mcg), 1 spray Nasal daily, Disp: 1 Bottle, RF: 3" size="80"][/conditional][checkbox memo="Flovent HFA (110 mcg)" name="Flov_3694" value=""][conditional field="Flov_3694" condition="(Flov_3694).is('')"] [text default="--Flovent HFA (110 mcg), 1 puff INH daily, Disp: 1 Inhaler, RF: 3" size="80"][/conditional][checkbox memo="Fluticasone" name="Flut" value=""][conditional field="Flut" condition="(Flut).is('')"] --Fluticasone (27.5 mcg/spray), [text name="Flut_dose" default="1" memo="1-2" size="2"] spray(s)/nostril, Spray [var name="Flut_dose" memo="#"] spray(s) in each nostril once daily, disp:1, RF: 3[/conditional][checkbox memo="Folic Acid (1 mg)" name="Foli_9378" value=""][conditional field="Foli_9378" condition="(Foli_9378).is('')"] [text default="--Folic Acid (1 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Fosamax (Alendronate) (70 mg)" name="Fosa_7294" value=""][conditional field="Fosa_7294" condition="(Fosa_7294).is('')"] [text default="--Fosamax (Alendronate) (70 mg), 1 tab PO weekly, Disp: 4, RF: 3" size="80"][/conditional][checkbox memo="Glucophage (Metformin HCL) (500 mg)" name="Gluc_2843" value=""][conditional field="Gluc_2843" condition="(Gluc_2843).is('')"] [text default="--Glucophage (Metformin HCL) (500 mg), 1 tab PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Glucophage (Metformin HCL) (1000 mg)" name="Gluc_2681" value=""][conditional field="Gluc_2681" condition="(Gluc_2681).is('')"] [text default="--Glucophage (Metformin HCL) (1000 mg), 1 tab PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Glucophage XR (Metformin ER) (500 mg)" name="Gluc_726" value=""][conditional field="Gluc_726" condition="(Gluc_726).is('')"] [text default="--Glucophage XR (Metformin ER) (500 mg), 1 tab PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Glucotrol XL (Glipizide ER) (5 mg)" name="Gluc_1818" value=""][conditional field="Gluc_1818" condition="(Gluc_1818).is('')"] [text default="--Glucotrol XL (Glipizide ER) (5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Glucotrol XL (Glipizide ER) (10 mg)" name="Gluc_4071" value=""][conditional field="Gluc_4071" condition="(Gluc_4071).is('')"] [text default="--Glucotrol XL (Glipizide ER) (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Hydrodiuril (Hydrochlorothiazide) (12.5 mg)" name="Hydr_5031" value=""][conditional field="Hydr_5031" condition="(Hydr_5031).is('')"] [text default="--Hydrodiuril (Hydrochlorothiazide) (12.5 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Hydrodiuril (Hydrochlorothiazide) (25 mg)" name="Hydr_2249" value=""][conditional field="Hydr_2249" condition="(Hydr_2249).is('')"] [text default="--Hydrodiuril (Hydrochlorothiazide) (25 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Hytone (Hydrocortisone) (2.5 %)" name="Hyto_8661" value=""][conditional field="Hyto_8661" condition="(Hyto_8661).is('')"] [text default="--Hytone (Hydrocortisone) (2.5 %), 1 app daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Ibuprofen (Ped)" name="Ibup" value=""][conditional field="Ibup" condition="(Ibup).is('')"] --Ibuprofen (100mg/5mL), [text name="Ibup_dose" default="10" memo="" size="2"] mg/kg ([calc memo="dose" value="Ibup_dose2=(kg)*(Ibup_dose)"] mg/dose), Take [calc memo="mL" value="Ibup_mL=((Ibup_dose2)*(5/100)).toFixed(1)"] mL every 6-8 hours as needed for pain/discomfort/temp >100.4F[/conditional][checkbox memo="Imitrex (Sumatriptan) (100 mg)" name="Imit_3507" value=""][conditional field="Imit_3507" condition="(Imit_3507).is('')"] [text default="--Imitrex (Sumatriptan) (100 mg), 1 tab PO daily, Disp: 14, RF: 3" size="80"][/conditional][checkbox memo="Januvia (100 mg)" name="Janu_1003" value=""][conditional field="Janu_1003" condition="(Janu_1003).is('')"] [text default="--Januvia (100 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="K-dur (Potassium) (20 mEq)" name="K-du_6153" value=""][conditional field="K-du_6153" condition="(K-du_6153).is('')"] [text default="--K-dur (Potassium) (20 mEq), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Keflex (Cephalexin) (500 mg)" name="Kefl_9955" value=""][conditional field="Kefl_9955" condition="(Kefl_9955).is('')"] [text default="--Keflex (Cephalexin) (500 mg), 1 cap PO QID, Disp: 28, RF: 0" size="80"][/conditional][checkbox memo="Ketoconazole" name="Ketoconazole" value=""][conditional field="Ketoconazole" condition="(Ketoconazole).is('')"] [text default="--Ketoconazole, 1 app per scalp q3-4 days for 8 weeks, Disp: 1 bottle, RF: 1" size="80"][/conditional][checkbox memo="Klonopin (Clonazepam) (1 mg)" name="Klon_408" value=""][conditional field="Klon_408" condition="(Klon_408).is('')"] [text default="--Klonopin (Clonazepam) (1 mg), 1 tab PO daily, Disp: 90, RF: 3" size="80"][/conditional][checkbox memo="KWIKPEN (Humalog) (75 -25)" name="KWIK_7765" value=""][conditional field="KWIK_7765" condition="(KWIK_7765).is('')"] [text default="--KWIKPEN (Humalog) (75 -25), 1 units SubQ daily, Disp: 1 vial, RF: 3" size="80"][/conditional][checkbox memo="Lamictal (Lamotrigine) (25 mg)" name="Lami_5964" value=""][conditional field="Lami_5964" condition="(Lami_5964).is('')"] [text default="--Lamictal (Lamotrigine) (25 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Lamisil (Terbinafine) (250 mg)" name="Lami_1807" value=""][conditional field="Lami_1807" condition="(Lami_1807).is('')"] [text default="--Lamisil (Terbinafine) (250 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Lanoxin (Digoxin) (0.125 mg)" name="Lano_670" value=""][conditional field="Lano_670" condition="(Lano_670).is('')"] [text default="--Lanoxin (Digoxin) (0.125 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Lantus" name="Lant_474" value=""][conditional field="Lant_474" condition="(Lant_474).is('')"] [text default="--Lantus, 1 units SubQ QHS, Disp: 1 vial, RF: 3" size="80"][/conditional][checkbox memo="Lasix (Furosemide) (20 mg)" name="Lasi_3883" value=""][conditional field="Lasi_3883" condition="(Lasi_3883).is('')"] [text default="--Lasix (Furosemide) (20 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Lasix (Furosemide) (40 mg)" name="Lasi_2144" value=""][conditional field="Lasi_2144" condition="(Lasi_2144).is('')"] [text default="--Lasix (Furosemide) (40 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Lexapro (Escitalopram) (10 mg)" name="Lexa_673" value=""][conditional field="Lexa_673" condition="(Lexa_673).is('')"] [text default="--Lexapro (Escitalopram) (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Lipitor (Atorvastatin) (10 mg)" name="Lipi_8168" value=""][conditional field="Lipi_8168" condition="(Lipi_8168).is('')"] [text default="--Lipitor (Atorvastatin) (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Lipitor (Atorvastatin) (20 mg)" name="Lipi_651" value=""][conditional field="Lipi_651" condition="(Lipi_651).is('')"] [text default="--Lipitor (Atorvastatin) (20 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Loestrin FE ( )" name="Loes_5773" value=""][conditional field="Loes_5773" condition="(Loes_5773).is('')"] [text default="--Loestrin FE ( ), 1 tab PO daily, Disp: 28, RF: 3" size="80"][/conditional][checkbox memo="Lopressor (Metoprolol) (50 mg)" name="Lopr_323" value=""][conditional field="Lopr_323" condition="(Lopr_323).is('')"] [text default="--Lopressor (Metoprolol) (50 mg), 1 tab PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Lotrisone (Clotrimazole/Betam) (1 %-0.05 %)" name="Lotr_1926" value=""][conditional field="Lotr_1926" condition="(Lotr_1926).is('')"] [text default="--Lotrisone (Clotrimazole/Betam) (1 %-0.05 %), 1 app daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Lyrica (50 mg)" name="Lyri_3546" value=""][conditional field="Lyri_3546" condition="(Lyri_3546).is('')"] [text default="--Lyrica (50 mg), 1 cap PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Macrobid (Nitrofurantoin) (100 mg)" name="Macr_5663" value=""][conditional field="Macr_5663" condition="(Macr_5663).is('')"] [text default="--Macrobid (Nitrofurantoin) (100 mg), 1 cap PO BIDfor 7 days, Disp: 14, RF: 0" size="80"][/conditional][checkbox memo="Maxzide (Triamterene/HCTZ) (37.5 mg)" name="Maxz_8806" value=""][conditional field="Maxz_8806" condition="(Maxz_8806).is('')"] [text default="--Maxzide (Triamterene/HCTZ) (37.5 mg), 1 tab PO daily, Disp: 30, RF: 3" 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name="Napr_1399" value=""][conditional field="Napr_1399" condition="(Napr_1399).is('')"] [text default="--Naprosyn (Naproxen) (500 mg), 1 tab PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Nasonex (25 mcg)" name="Naso_8238" value=""][conditional field="Naso_8238" condition="(Naso_8238).is('')"] [text default="--Nasonex (25 mcg), 1 spray Nasal daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Neurotin (Gabapentin) (300 mg)" name="Neur_4621" value=""][conditional field="Neur_4621" condition="(Neur_4621).is('')"] [text default="--Neurotin (Gabapentin) (300 mg), 1 cap PO daily, Disp: 90, RF: 3" size="80"][/conditional][checkbox memo="Nexium (40 mg)" name="Nexi_3738" value=""][conditional field="Nexi_3738" condition="(Nexi_3738).is('')"] [text default="--Nexium (40 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Norvasc (Amlodipine) (10 mg)" name="Norv_7362" value=""][conditional field="Norv_7362" condition="(Norv_7362).is('')"] [text default="--Norvasc (Amlodipine) (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Paxil (Paroxetine) (20 mg)" name="Paxi_712" value=""][conditional field="Paxi_712" condition="(Paxi_712).is('')"] [text default="--Paxil (Paroxetine) (20 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Penicillin-VK (500 mg)" name="Peni_3607" value=""][conditional field="Peni_3607" condition="(Peni_3607).is('')"] [text default="--Penicillin-VK (500 mg), 1 tab PO QID for 10 days, Disp: 40, RF: 0" size="80"][/conditional][checkbox memo="Percocet (Oxycodone/Acetaminophen) (5 /325 mg)" name="Perc_5054" value=""][conditional field="Perc_5054" condition="(Perc_5054).is('')"] [text default="--Percocet (Oxycodone/Acetaminophen) (5 /325 mg), 1 tab PO every 6 hours for 5 days, Disp: 30, RF: 0" size="80"][/conditional][checkbox memo="Plavix (Clopidogrel) (75 mg)" name="Plav_8114" value=""][conditional field="Plav_8114" condition="(Plav_8114).is('')"] [text default="--Plavix (Clopidogrel) (75 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Pravachol (Pravastatin) (20 mg)" name="Prav_4373" value=""][conditional field="Prav_4373" condition="(Prav_4373).is('')"] [text default="--Pravachol (Pravastatin) (20 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Prednisone (5 mg) - 5 Days" name="Pred_332" value=""][conditional field="Pred_332" condition="(Pred_332).is('')"] [text default="--Prednisone (5 mg), 1 tab PO QAM, Disp: 5, RF: 0" size="80"][/conditional][checkbox memo="Prednisone (20 mg)" name="Pred_1878" value=""][conditional field="Pred_1878" condition="(Pred_1878).is('')"] [text default="--Prednisone (20 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Premarin (0.625 mg)" name="Prem_3208" value=""][conditional field="Prem_3208" condition="(Prem_3208).is('')"] [text default="--Premarin (0.625 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Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Protonix (Pantoprazole) (40 mg)" name="Prot_2237" value=""][conditional field="Prot_2237" condition="(Prot_2237).is('')"] [text default="--Protonix (Pantoprazole) (40 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Proventil (90 mcg)" name="Prov_7658" value=""][conditional field="Prov_7658" condition="(Prov_7658).is('')"] [text default="--Proventil (90 mcg), 1 puff INH daily, Disp: 1 MDI, RF: 3" size="80"][/conditional][checkbox memo="Proventil (Albuterol) (0.08 %)" name="Prov_4348" value=""][conditional field="Prov_4348" condition="(Prov_4348).is('')"] [text default="--Proventil (Albuterol) (0.08 %), 1 puff INH daily, Disp: 1 MDI, RF: 3" size="80"][/conditional][checkbox memo="Pyridium" name="Pyr" value=""][checkbox memo="Pyridium (200 mg)" name="Pyri_5011" value=""][conditional field="Pyri_5011" condition="(Pyri_5011).is('')"] [textarea default="--Pyridium (200 mg), 1 tab PO TID for 2 days, Disp: 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size="80"][/conditional][checkbox memo="Singulair (Montelukast SOD) (10 mg)" name="Sing_6939" value=""][conditional field="Sing_6939" condition="(Sing_6939).is('')"] [text default="--Singulair (Montelukast SOD) (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Spiriva (18 mcg)" name="Spir_130" value=""][conditional field="Spir_130" condition="(Spir_130).is('')"] [text default="--Spiriva (18 mcg), 1 puff INH daily, Disp: 1 MDI, RF: 3" size="80"][/conditional][checkbox memo="Strattera (18 mg)" name="Stra_6584" value=""][conditional field="Stra_6584" condition="(Stra_6584).is('')"] [text default="--Strattera (18 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Synthroid (Levothyroxine) (50 mcg)" name="Synt_5136" value=""][conditional field="Synt_5136" condition="(Synt_5136).is('')"] [text default="--Synthroid (Levothyroxine) (50 mcg), 1 tab PO daily, Disp: 30, RF: 3, take before morning meal" size="80"][/conditional][checkbox memo="Synthroid (Levothyroxine) (100 mcg)" name="Synt_67" value=""][conditional field="Synt_67" condition="(Synt_67).is('')"] [text default="--Synthroid (Levothyroxine) (100 mcg), 1 tab PO daily, Disp: 30, RF: 3, take before morning meal" size="80"][/conditional][checkbox memo="Tenormin (Atenolol) (25 mg)" name="Teno_7198" value=""][conditional field="Teno_7198" condition="(Teno_7198).is('')"] [text default="--Tenormin (Atenolol) (25 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Tenormin (Atenolol) (50 mg)" name="Teno_5605" value=""][conditional field="Teno_5605" condition="(Teno_5605).is('')"] [text default="--Tenormin (Atenolol) (50 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Terazol (Terconazole 0.80%) ( )" name="Tera_9368" value=""][conditional field="Tera_9368" condition="(Tera_9368).is('')"] [text default="--Terazol (Terconazole 0.80%) ( ), 1 supp PV BID for 10 days, Disp: 20, RF: 3" size="80"][/conditional][checkbox memo="Topamax (Topiramate) (50 mg)" name="Topa_4605" value=""][conditional field="Topa_4605" condition="(Topa_4605).is('')"] [text default="--Topamax (Topiramate) (50 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Toprol XL (Metoprolol XL) (50 mg)" name="Topr_9959" value=""][conditional field="Topr_9959" condition="(Topr_9959).is('')"] [text default="--Toprol XL (Metoprolol XL) (50 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="tri-cyclen (Tri-Sprintec) ( )" name="tri-_7180" value=""][conditional field="tri-_7180" condition="(tri-_7180).is('')"] [text default="--tri-cyclen (Tri-Sprintec) ( ), 1 tab PO daily, Disp: 28, RF: 3" size="80"][/conditional][checkbox memo="Tricor (145 mg)" name="Tric_934" value=""][conditional field="Tric_934" condition="(Tric_934).is('')"] [text default="--Tricor (145 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Truvada" name="Truv_772" value=""][conditional field="Truv_772" condition="(Truv_772).is('')"] [text default="--Truvada, 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Tylenol/Codeine (Acetaminophen/Codeine) (30 mg)" name="Tyle_7510" value=""][conditional field="Tyle_7510" condition="(Tyle_7510).is('')"] [text default="--Tylenol/Codeine (Acetaminophen/Codeine) (30 mg), 1 tab PO every 6 hours as needed, Disp: 30, RF: 0" size="80"][/conditional][checkbox memo="Ultram (Tramadol) (50 mg)" name="Ultr_4740" value=""][conditional field="Ultr_4740" condition="(Ultr_4740).is('')"] [text default="--Ultram (Tramadol) (50 mg), 1 tab PO every 4-6 hours as needed for pain, Disp: 18, RF: 0" size="80"][/conditional][checkbox memo="Valtrex (Valacyclovir) (500 mg)" name="Valt_5002" value=""][conditional field="Valt_5002" condition="(Valt_5002).is('')"] [text default="--Valtrex (Valacyclovir) (500 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Vasotec (Enalapril) (10 mg)" name="Vaso_104" value=""][conditional field="Vaso_104" condition="(Vaso_104).is('')"] [text default="--Vasotec (Enalapril) (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Ventolin HFA" name="Vent_7291" value=""][conditional field="Vent_7291" condition="(Vent_7291).is('')"] [text default="--Ventolin HFA, 4 puffs INH daily, Disp: 1 MDI, RF: 3" size="80"][/conditional][checkbox memo="Ventolin HFA (Rescue)" name="Vent_72" value=""][conditional field="Vent_72" condition="(Vent_72).is('')"] [text default="--Ventolin HFA (Rescue), 2 puffs INH Q3-4 Hrs PRN Wheezing, Disp: 1 MDI, RF: 3" size="80"][/conditional][checkbox memo="Viagra (100 mg)" name="Viag_4754" value=""][conditional field="Viag_4754" condition="(Viag_4754).is('')"] [text default="--Viagra (100 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Vibramycin (Doxycycline) (100 mg)" name="Vibr_5517" value=""][conditional field="Vibr_5517" condition="(Vibr_5517).is('')"] [text default="--Vibramycin (Doxycycline) (100 mg), 1 cap PO daily, Disp: 30, RF: 0" size="80"][/conditional][checkbox memo="Vicodin (Hydrocodone/Acetominophen) (5 mg/500 mg)" name="Vico_3544" value=""][conditional field="Vico_3544" condition="(Vico_3544).is('')"] [text default="--Vicodin (Hydrocodone/Acetominophen) (5 mg/500 mg), 1 tab PO daily, Disp: 30, RF: 0" size="80"][/conditional][checkbox memo="Vicodin (Hydrocodone/Acetominophen) (7.5 mg/750 mg)" name="Vico_7273" value=""][conditional field="Vico_7273" condition="(Vico_7273).is('')"] [text default="--Vicodin (Hydrocodone/Acetominophen) (7.5 mg/750 mg), 1 tab PO daily, Disp: 30, RF: 0" size="80"][/conditional][checkbox memo="Vitamin D (50000 units)" name="Vita_3857" value=""][conditional field="Vita_3857" condition="(Vita_3857).is('')"] [text default="--Vitamin D (50000 units), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Vytorin (10 mg/20 mg)" name="Vyto_3536" value=""][conditional field="Vyto_3536" condition="(Vyto_3536).is('')"] [text default="--Vytorin (10 mg/20 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Wellbutrin SR (Bupropion SR) (150 mg)" name="Well_1069" value=""][conditional field="Well_1069" condition="(Well_1069).is('')"] [text default="--Wellbutrin SR (Bupropion SR) (150 mg), 1 tab PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Xalatan (Latanoprost) (0.01 %)" name="Xala_6101" value=""][conditional field="Xala_6101" condition="(Xala_6101).is('')"] [text default="--Xalatan (Latanoprost) (0.01 %), 1 gtts daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Xanax (Alprazolam) (0.5 mg)" name="Xana_8276" value=""][conditional field="Xana_8276" condition="(Xana_8276).is('')"] [text default="--Xanax (Alprazolam) (0.5 mg), 1 tab PO TID, Disp: 90, RF: 0" size="80"][/conditional][checkbox memo="Yaz (3 mg/ .02 mg)" name="Yaz_2628" value=""][conditional field="Yaz_2628" condition="(Yaz_2628).is('')"] [text default="--Yaz (3 mg/ .02 mg), 1 tab PO daily, Disp: 28, RF: 0" size="80"][/conditional][checkbox memo="Zantac (Ranitidine) (150 mg)" name="Zant_7387" value=""][conditional field="Zant_7387" condition="(Zant_7387).is('')"] [text default="--Zantac (Ranitidine) (150 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Zestoretic (Lisinopril/Hctz) (20 mg/12.5 mg)" name="Zest_8507" value=""][conditional field="Zest_8507" condition="(Zest_8507).is('')"] [text default="--Zestoretic (Lisinopril/Hctz) (20 mg/12.5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Zofran (Ondansetron) (4 mg)" name="Zof" value=""][conditional field="Zof" condition="(Zof).is('')"] --Zofran ([text name="Zof_dose" default="8" memo="4-8" size="2"] mg), SL, PRN TID N/V, disp: 15, refill(s) 1[/conditional][conditional field="Zest_8507" condition="(Zest_8507).is('')"] [text default="--Zestoretic (Lisinopril/Hctz) (20 mg/12.5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Zyrtec (Cetirizine) (5 mg)" name="Zyrtec" value=""][conditional field="Zyrtec" condition="(Zyrtec).is('')"] --Zyrtec ([text name="Zyrtec_dose" default="5" memo="5-10" size="2"] mg), PO Daily, disp: 30, RF: 3[/conditional]
Result - Copy and paste this output:
Sandbox Metrics: Structured Data Index 0.5, 547 form elements, 184 text boxes, 1 text areas, 157 checkboxes, 28 drop downs, 8 variables, 12 calculations, 157 conditionals, 370 total clicks
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