Preventative Screenings

Screenings for [select name="formtype" value="Females less than 65yo|Females greater than 65yo|Males less than 65yo|Males greater than 65yo"]

[conditional field="formtype" condition="(formtype).is('Females less than 65yo')"]
Cardiovascular Disease Screening:
Blood pressure screening was performed at this visit
[checkbox name="bp" value="Next screen due in 2 years as BP is less than 120/80|Next screen due in 1 year as BP is less than 140/90 and patient under 60yo|Next screen due in 1 year as BP is less than 150/90 and patient over 60yo|See HTN plan above"]

Dyslipidemia Screening:
I discussed the risks and benefits of lipid screening with the patient:
[checkbox name="lipids-risk" value="Patient is 17-21 and has elected to undergo one-time lipid screening|Patient has risk factors for dyslipidemia (HTN, obesity, DM, personal or family history) and is 20yo or older and screening is recommended|Patient has no risk factors"]
[checkbox name="lipids-test" value="Screening recommended, patient agreeable, lipid panel ordered|Screening recommended, patient declines screening|No risk factors present, screening not indicated"]

Patient’s ASCVD risk score is [text name="ascvd-risk" default=""]%
[checkbox name="variable_1" value="Patient is on a medium-dose statin|Patient is on a high-dose statin|Patient is on aspirin|No further intervention required"]

Weight Control:
BMI screening performed today
[checkbox name="weight" value="Patient BMI less than 18.5, see underweight plan above|Patient BMI within normal limits, discussed healthy diet and exercise recommendations to maintain weight|Patient BMI 25 or greater, discussed and provided information on exercise and diet for weight loss|Patient’s BMI >25 and CVD risk factors (HTN, HLD, DM, personal or family history) or greater than 30,  see obesity plan above"]

Diabetes Screening:
Patient has the following risk factors: [checkbox name="dm-risks" value="sustained BP >140/90|>45yo|BMI >25|Physical inactivity|First degree relative with DM|High-risk race/ethnicity (African American, Latino, Native American, Asian, Pacific Islander)|Hx of GDM|HDL <35 and/or a triglyceride level >250|PCOS|severe obesity|acanthosis nigricans|CVD|none"]
Last A1C: [text name="a1c" default=""]
Last Blood Glucose: [text name="bg" default=""]
Based on the above risk factors:
[checkbox name="dm-plan" value="Screening indicated, ordering A1c|Screening indicated, ordering fasting blood glucose|Screening indicated, ordering random blood glucose|Screening is not indicated"]

Cervical Cancer:
Indication: [checkbox name="pap" value="Patient is between 21-29 and therefore requires PAP screen every 3 years|Patient is 30 or above and requires PAP every 3 years, or PAP + HPV every 5 years"]

BRCA-Related Cancer:
Indication: [checkbox name="brca" value="Patient is 18 years or older and has a family member with Breast, Ovarian, Tubal, or Peritoneal Cancer|None"]
Plan:[checkbox name="bcra-plan" value="Patient found to be at risk for BRCA-related cancer and will undergo genetic counseling and possibly BRCA mutation testing|Patient found to be at risk for BRCA-related cancer and refuses genetic counseling and screening|Patient not found to be at risk for BRCA-related cancer, assess patient for changes in family history in 5 to 10 years"]


[conditional field="formtype" condition="(formtype).is('Females greater than 65yo')"]


[conditional field="formtype" condition="(formtype).is('Males less than 65yo')"]


[conditional field="formtype" condition="(formtype).is('Males greater than 65yo')"]

Screenings for

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.79, 18 form elements, 2 boilerplate words, 3 text boxes, 10 checkboxes, 1 drop downs, 4 conditionals, 46 total clicks
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