PWF3w – AP Well Adult – Physician Workflow Part 3w

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 memo=">1 sexual parner in last year, hx of STIs, receptive anal intercourse" memo_size="small" memo_color="yellow" name="wellvisitAPhighrisksex" value="no|yes"][checkbox memo="ASCVD risk" memo_size="small" memo_color="pink" name="ASCVD" value=""][conditional field="ASCVD" condition="(ASCVD).is('')"]
-ASCVD 10yr risk [text name="ASCVDnumber" size="5"] %
[/conditional]
-Spent [text size="5"] minutes discussing the following preventative health topics and screenings:
[conditional field="ASCVD|ASCVDnumber" condition="((ASCVD).is('')&&(ASCVDnumber).isGreaterOrEqual('7.5'))"][checkbox name="ASCVDdisc" value=" -Elevated ASCVD risk - discussed statin therapy for primary prevention - "]
[/conditional][conditional field="ASCVD|ASCVDnumber|ASCVDdisc" condition="((ASCVD).is('')&&(ASCVDnumber).isGreaterOrEqual('7.5')&&(ASCVDdisc).is(' -Elevated ASCVD risk - discussed statin therapy for primary prevention - '))"][select value="|continue current statin therapy|patient agreed, initiated statin therapy|patient declined, address at next visit|patient with significant side effects and/or contraindications to statin therapy"][textarea memo="ASCVD freetext" memo_size="small" rows="2"]
[/conditional][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 uptodate for screening|patient due for screening|patient declined/deferred|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('15')&&(wellvisitAPage).isLessOrEqual('65'))&&((wellvisitAPgender).is('F'))"][checkbox memo="F planning or capable of having children" memo_size="small" memo_color="yellow" name="USPSTFg61" value=" -Folic acid 0.4-0.8mg daily supplementation to prevent neural tube defects"][/conditional][conditional field="USPSTFg61" condition="(USPSTFg61).is(' -Folic acid 0.4-0.8mg daily supplementation to prevent neural tube defects')"] - [checkbox value="patient already taking|patient declined|patient accepted/requested|medication prescribed|patient preferred OTC prep, gave recommendations|not indicated for patient at this time"]
[/conditional][conditional field="wellvisitAPage|wellvisitAPgender|wellvisitAPmenopause" condition="((wellvisitAPage).isLessOrEqual('64'))&&((wellvisitAPgender).is('F'))&&((wellvisitAPmenopause).is('premenopausal')||(wellvisitAPmenopause).is('perimenopausal'))"][checkbox name="femalecontracep" value=" -Contraception Management"][/conditional][conditional field="femalecontracep" condition="(femalecontracep).is(' -Contraception Management')"]
-Current Method - [select memo="*" memo_size="small" memo_color="blue" name="contra1" value="choose below|Pill|Patch|Ring|Progestin shot|Progestin implant|Hormone IUD|Copper IUD|abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method|BTL|partner vasectomy"]
-After discussion and shared decision making, [checkbox name="contrasatisfac" value="patient desires to continue current method and understands risks & benefits & alternatives to current method|patient desires/agreeable to switching methods"]
[/conditional][conditional field="contrasatisfac" condition="(contrasatisfac).is('patient desires to continue current method and understands risks & benefits & alternatives to current method')"] -Actions: [checkbox value="IUD not currently due for replacing|IUD due for replacing & patient referred/scheduled for procedure|Progestin implant not currently due for replacing|Progestin implant due for replacing & patient referred/scheduled for procedure|Next progestin injection not yet due|Next progestin IM injection due and ordered/rx'd|Current contraceptive with adequate supply/refills|Current contraceptive supply low and needs refill, prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient resuming contraceptivez|Permanent contraceptive method without issues, will continue"]
[/conditional][conditional field="contrasatisfac" condition="(contrasatisfac).is('patient desires/agreeable to switching methods')"]
-New Desired Method - [select memo="*" memo_size="small" memo_color="blue" name="contra2" value="choose below|Pill|Patch|Ring|Progestin shot|Progestin implant|Hormone IUD|Copper IUD|abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method|BTL|partner vasectomy"]
-Recommendations to minimize gaps in contraception coverage and unintended pregnancy -->
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')&&(contra2).is('Pill')"] -Option (1) Take first pill as soon as pill pack received.
-Option (2) Take your first pill soon after next period begins.
-If first pill taken ≤ 5 days after the start of menses, no backup method needed.
-If first pill taken > 5 days after the start of your period, use back-up method for the first 7 days
-Take 1 pill each day. Take pill at the same time each day (especially if progestin-only pill).
-After finishing a pack of pills, start a new pack the next day. Should have NO day without a pill.
-If missed ONE pill: Take pill as soon as possible.
-If missed TWO pills or more: Take pill as soon as possible. Take next pill at the
usual time. Use condoms for 7 days. Use emergency contraception if having
unprotected sex.
-Actions: [checkbox value="New OCP prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient taking new OCP"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')&&(contra2).is('Patch')"] -Option (1) Put on first patch as soon as pack received.
-Option (2) Put on first patch soon after next period begins.
-If first patch put on ≤ 5 days after the start of menses, no backup method needed.
-If first patch put on > 5 days after the start of your period, use back-up method for the first 7 days
-Use new patch every week for 3 weeks and no patch for the 4th week.
-Expect menses during the patch-free week. May have a light menses or no menses at all.
-Start a new box of patches at the end of the 4th week.
-If the patch comes off, put it back on right away. If it does not stick, use a new patch.
-If the patch falls off for more than a day, put on new patch and use condoms for the next 7 days. Put on next patch a week from the date of this new patch.
-If forgot to change patch after 7 days:
-patch has enough hormones for 9 days; if patch on for 9 days or less put on a new patch.
-If patch on for more than 9 days, put on a new patch and use condoms for the next 7 days.
-Actions: [checkbox value="Patch prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient using patch"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')&&(contra2).is('Ring')"] -Option (1) Put in first ring as soon as pack received.
-Option (2) Put in first ring soon after next period begins.
-If first ring put in ≤ 5 days after the start of menses, no backup method needed.
-If first ring put in > 5 days after the start of your period, use back-up method for the first 7 days
-Leave the ring in vagina for 3 weeks, and remove it for the 4th week.
-Ring is removed by hooking a finger under the rim and pulling it out.
-Most women have menses during the ring-free week.
-Insert a new ring at the end of the 4th week.
-Can store the ring at room temperature up to four months. In the refrigerator, the ring lasts
much longer.
-If no/reduced menses desired and because the ring has enough hormones to last 35 days, can leave in for more than 3 weeks. Change the ring on the same day of each month (for instance, March 1st, April 1st, May 1st, etc.). If removing the old ring and inserting the new ring on the same day, may not have menses.
-If ring comes out: the ring can stay out of body for up to 3 hours and still prevent pregnancy. If the ring is out of body for more than 3 hours, put it back into vagina and use condoms for the next 7 days.
-Actions: [checkbox value="Vaginal ring prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient inserting ring"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')&&(contra2).is('Progestin shot')"] -Use back-up method for the first 7 days following injection.
-Actions: [checkbox name="depoinj1" value="Progestin IM injection ordered and to be administered in clinic|Progestin IM injection prescribed, instructed to pickup on pharmacy and bring to clinic for administration|No HCG test required|HCG negative|HCG ordered and f/u results prior to injection being administered"]
[/conditional][conditional field="depoinj1" condition="(depoinj1).is('Progestin IM injection ordered and to be administered in clinic')"] -Date estimated/anticipated given: [date name="DepoDate1" default="today"]
-Next window: [calc memo="calc value" value="score1=(DepoDate1).dateAdd(77)"] THRU [calc memo="calc value" value="score1=(DepoDate1).dateAdd(105)"] [comment memo="11-15wk range backed by high quality evidence of efficacy" memo_size="small" memo_color="yellow"].
-If miss window for next injection, will need pregnancy test prior to injection.
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')&&(contra2).is('Progestin implant')"] -Use back-up method for the first 7 days following implant insertion.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')&&(contra2).is('Hormone IUD')"] -Use back-up method for the first 7 days following IUD insertion.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')&&(contra2).is('Copper IUD')"] -Use back-up method for the first 7 days following IUD insertion.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Pill')&&(contra2).is('Pill')"] -Assuming no gap: take 1st pill of new pack the day after taking any pill in old pack (regardless of timing of cycle, patient may wait until completion of old pack before starting new pack/contraceptive if desired).
-Actions: [checkbox value="Patient desiring/agreeable to switching to different oral contraceptive pill due to reasons previously described|New OCP prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient taking new OCP"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Pill')&&(contra2).is('Patch')"] -Goal of 1 day overlap of old and new methods.
-Start patch 1 day before stopping pill or continue taking pill for 1 day after placing patch.
-Actions: [checkbox value="Patch prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient placing patch"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Pill')&&(contra2).is('Ring')"] -Assuming no gap: no overlap required, insert ring the day after taking any pill in pack.
-Actions: [checkbox value="Vaginal ring prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient inserting vaginal ring"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Pill')&&(contra2).is('Progestin shot')"] -Goal of 7 day overlap of old and new methods.
-Have first injection 7 days before stopping pill or continue taking pill for 7 days after getting injection.
-Actions: [checkbox name="depoinj2" value="Progestin IM injection ordered and to be administered in clinic|Progestin IM injection prescribed, instructed to pickup on pharmacy and bring to clinic for administration|No HCG test required|HCG negative|HCG ordered and f/u results prior to injection being administered"]
[/conditional][conditional field="depoinj2" condition="(depoinj2).is('Progestin IM injection ordered and to be administered in clinic')"] -Date estimated/anticipated given: [date name="DepoDate2" default="today"]
-Next window: [calc memo="calc value" value="score1=(DepoDate2).dateAdd(77)"] THRU [calc memo="calc value" value="score1=(DepoDate2).dateAdd(105)"] [comment memo="11-15wk range backed by high quality evidence of efficacy" memo_size="small" memo_color="yellow"].
-If miss window for next injection, will need pregnancy test prior to injection.
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Pill')&&(contra2).is('Progestin implant')"] -Goal of 4 day overlap of old and new methods.
-Have implant inserted 4 days before stopping pill or continue taking pill for 4 days after getting implant inserted.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Pill')&&(contra2).is('Hormone IUD')"] -Goal of 7 day overlap of old and new methods.
-Have hormone IUD inserted 7 days before stopping pill or continue taking pill for 7 days after getting hormone IUD inserted.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Pill')&&(contra2).is('Copper IUD')"] -Have copper IUD inserted no more than 5 days after stopping pill. No overlap needed.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Patch')&&(contra2).is('Pill')"] -Goal of 1 day overlap of old and new methods.
-Start pill 1 day before stopping patch or keep wearing patch for 1 day after taking first pill.
-Actions: [checkbox value="Patient desiring/agreeable to switching to oral contraceptive pill due to reasons previously described|New OCP prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient taking new OCP"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Patch')&&(contra2).is('Ring')"] -Assuming no gap: insert ring and remove patch on the same day. No overlap required.
-Actions: [checkbox value="Vaginal ring prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient inserting ring"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Patch')&&(contra2).is('Progestin shot')"] -Goal of 7 days overlap of old and new methods.
-Have First injection 7 days before stopping patch or keep wearing patch for 7 days after injection.
-Actions: [checkbox name="depoinj3" value="Progestin IM injection ordered and to be administered in clinic|Progestin IM injection prescribed, instructed to pickup on pharmacy and bring to clinic for administration|No HCG test required|HCG negative|HCG ordered and f/u results prior to injection being administered"]
[/conditional][conditional field="depoinj3" condition="(depoinj3).is('Progestin IM injection ordered and to be administered in clinic')"] -Date estimated/anticipated given: [date name="DepoDate3" default="today"]
-Next window: [calc memo="calc value" value="score1=(DepoDate3).dateAdd(77)"] THRU [calc memo="calc value" value="score1=(DepoDate3).dateAdd(105)"] [comment memo="11-15wk range backed by high quality evidence of efficacy" memo_size="small" memo_color="yellow"].
-If miss window for next injection, will need pregnancy test prior to injection.
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Patch')&&(contra2).is('Progestin implant')"] -Goal of 4 days overlap between old and new methods.
-Have progestin implant inserted 4 days before stopping patch or keep wearing patch for 4 days after implant insertion.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Patch')&&(contra2).is('Hormone IUD')"] -Have hormone IUD inserted 7 days before stopping patch or keep wearing patch for 7 days after hormone IUD inserted.
-Goal of 7 days overlap between old and new methods.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Patch')&&((contra2).is('Copper IUD')"] -Have copper IUD inserted no more than 5 days after removing patch. No overlap needed.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Ring')&&(contra2).is('Pill')"] -Goal of 1 day of overlap between old and new methods.
-Start pill 1 day before removing ring or keep in ring for 1 day after starting pill pack.
-Actions: [checkbox value="New OCP prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient taking new OCP"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Ring')&&(contra2).is('Patch')"] -Goal of 2 days of overlap between old and new methods.
-Start patch 2 days before stopping ring or keep in ring for 2 days after placing patch.
-Actions: [checkbox value="Patch prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient using patch"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Ring')&&(contra2).is('Progestin shot')"] -Goal of 7 days of overlap between old and new methods.
-Have first injection 7 days before stopping ring or keep in ring for 7 days after having first injection.
-Actions: [checkbox name="depoinj4" value="Progestin IM injection ordered and to be administered in clinic|Progestin IM injection prescribed, instructed to pickup on pharmacy and bring to clinic for administration|No HCG test required|HCG negative|HCG ordered and f/u results prior to injection being administered"]
[/conditional][conditional field="depoinj4" condition="(depoinj4).is('Progestin IM injection ordered and to be administered in clinic')"] -Date estimated/anticipated given: [date name="DepoDate4" default="today"]
-Next window: [calc memo="calc value" value="score1=(DepoDate4).dateAdd(77)"] THRU [calc memo="calc value" value="score1=(DepoDate4).dateAdd(105)"] [comment memo="11-15wk range backed by high quality evidence of efficacy" memo_size="small" memo_color="yellow"].
-If miss window for next injection, will need pregnancy test prior to injection.
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Ring')&&(contra2).is('Progestin implant')"] -Goal of 4 days of overlap between old and new methods.
-Have implant inserted 4 days before stopping ring or keep in ring for 4 days after having implant inserted.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Ring')&&(contra2).is('Hormone IUD')"] -Goal of 7 days of overlap between old and new methods.
-Have hormone IUD inserted 7 days before stopping ring or keep in ring for 7 days after having hormone IUD inserted.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Ring')&&(contra2).is('Copper IUD')"] -Have copper IUD inserted no more than 5 days after removing ring. No overlap required.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Progestin shot')&&(contra2).is('Pill')"] -Start pill pack up to 15 weeks after the last injection.
-Actions: [checkbox value="New OCP prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient taking new OCP"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Progestin shot')&&(contra2).is('Patch')"] -Place patch up to 15 weeks after the last injection.
-Actions: [checkbox value="Patch prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient using patch"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Progestin shot')&&(contra2).is('Ring')"] -Insert ring up to 15 weeks after the last injection.
-Actions: [checkbox value="Vaginal ring prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient inserting ring"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Progestin shot')&&(contra2).is('Progestin implant')"] -Have implant inserted up to 15 weeks after the last injection.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Progestin shot')&&(contra2).is('Hormone IUD')"] -Have hormone IUD inserted up to 15 weeks after the last injection.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Progestin shot')&&(contra2).is('Copper IUD')"] -Have copper IUD inserted up to 16 weeks after the last injection.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Progestin implant')&&(contra2).is('Pill')"] -Goal of 7 days overlap between old and new methods.
-Start pill pack 7 days before implant is removed or continue pill pack for 7 days after implant is removed.
-Actions: [checkbox value="New OCP prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient taking new OCP"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Progestin implant')&&(contra2).is('Patch')"] -Goal of overlap of 7 days between old and new methods.
-Place patch 7 days before implant is removed or use backup contraception for first 7 days after after removal and placing patch.
-Actions: [checkbox value="Patch prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient using patch"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Progestin implant')&&(contra2).is('Ring')"] -Goal of overlap of 7 days between old and new methods.
-Insert ring 7 days before implant is removed or use backup contraception for first 7 days after implant removal and insertion of ring.
-Actions: [checkbox value="Vaginal ring prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient inserting ring"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Progestin implant')&&(contra2).is('Progestin shot')"] -Goal of 7 days of overlap between old and new methods.
-Have first injection 7 days before implant is removed or use backup contraception for 7 days after removal of implant and first injection.
-Actions: [checkbox name="depoinj5" value="Progestin IM injection ordered and to be administered in clinic|Progestin IM injection prescribed, instructed to pickup on pharmacy and bring to clinic for administration|No HCG test required|HCG negative|HCG ordered and f/u results prior to injection being administered"]
[/conditional][conditional field="depoinj5" condition="(depoinj5).is('Progestin IM injection ordered and to be administered in clinic')"] -Date estimated/anticipated given: [date name="DepoDate5" default="today"]
-Next window: [calc memo="calc value" value="score1=(DepoDate5).dateAdd(77)"] THRU [calc memo="calc value" value="score1=(DepoDate5).dateAdd(105)"] [comment memo="11-15wk range backed by high quality evidence of efficacy" memo_size="small" memo_color="yellow"].
-If miss window for next injection, will need pregnancy test prior to injection.
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Progestin implant')&&(contra2).is('Hormone IUD') -Goal of 7 days of overlap between old and new methods.
-Have hormone IUD inserted 7 days before implant is removed or use backup contraception for 7 days after removal of implant and insertion of hormone IUD.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Progestin implant')&&(contra2).is('Copper IUD')"] -Have copper IUD inserted no more than 5 days after implant is removed or use backup contraception until copper IUD inserted. No overlap required.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Hormone IUD')&&(contra2).is('Pill')"] -Goal of 7 days of overlap between old and new methods.
-Start pill pack 7 days before hormone IUD is removed or use backup contraception for 7 days after removal of IUD and starting pill pack.
-Actions: [checkbox value="New OCP prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient taking new OCP"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Hormone IUD')&&(contra2).is('Patch')"] -Goal of 7 days of overlap between old and new methods.
-Place patch 7 days before IUD is removed or use backup contraception for 7 days after removal of hormone IUD and placing patch.
-Actions: [checkbox value="Patch prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient using patch"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Hormone IUD')&&(contra2).is('Ring')"] -Goal of 7 days of overlap between old and new methods.
-Insert ring 7 days before IUD is removed or use backup contraception for 7 days after removal of hormone IUD and insertion of ring.
-Actions: [checkbox value="Vaginal ring prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient inserting ring"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Hormone IUD')&&(contra2).is('Progestin shot')"] -Goal of 7 days of overlap between old and new methods.
-Have first injection 7 days before hormone IUD is removed or use backup contraception for 7 days after removal of hormone IUD and first injection.
-Actions: [checkbox name="depoinj6" value="Progestin IM injection ordered and to be administered in clinic|Progestin IM injection prescribed, instructed to pickup on pharmacy and bring to clinic for administration|No HCG test required|HCG negative|HCG ordered and f/u results prior to injection being administered"]
[/conditional][conditional field="depoinj6" condition="(depoinj6).is('Progestin IM injection ordered and to be administered in clinic')"] -Date estimated/anticipated given: [date name="DepoDate6" default="today"]
-Next window: [calc memo="calc value" value="score1=(DepoDate6).dateAdd(77)"] THRU [calc memo="calc value" value="score1=(DepoDate6).dateAdd(105)"] [comment memo="11-15wk range backed by high quality evidence of efficacy" memo_size="small" memo_color="yellow"].
-If miss window for next injection, will need pregnancy test prior to injection.
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Hormone IUD')&&(contra2).is('Progestin implant')"] -Goal of 4 days of overlap between old and new methods.
-Have implant inserted 4 days before hormone IUD is removed or use backup contraception for 4 days after removal of hormone IUD and insertion of implant.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Hormone IUD')&&(contra2).is('Copper IUD')"] -Have copper IUD inserted right after hormone IUD is removed. No overlap required.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Copper IUD')&&(contra2).is('Pill')"] -Goal of 7 days of overlap between old and new methods.
-Start pill pack 7 days before copper IUD is removed or use backup contraception for 7 days after removal of copper IUD and starting pill pack.
-Actions: [checkbox value="New OCP prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient taking new OCP"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Copper IUD')&&(contra2).is('Patch')"] -Goal of 7 days of overlap between old and new methods.
-Place patch 7 days before copper IUD is removed or use backup contraception for 7 days after removal of copper IUD and placing patch.
-Actions: [checkbox value="Patch prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient using patch"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Copper IUD')&&(contra2).is('Ring')"] -Goal of 7 days of overlap between old and new methods.
-Insert ring 7 days before copper IUD is removed or use backup contraception for 7 days after removal of copper IUD and inserting ring.
-Actions: [checkbox value="Vaginal ring prescribed and patient to pickup on pharmacy|No HCG test required|HCG negative|HCG ordered and f/u results prior to patient inserting ring"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Copper IUD')&&(contra2).is('Progestin shot')"] -Goal of 7 days of overlap between old and new methods.
-Have first injection 7 days before copper IUD is removed or use backup contraception for 7 days after removal of copper IUD and first injection.
-Actions: [checkbox name="depoinj7" value="Progestin IM injection ordered and to be administered in clinic|Progestin IM injection prescribed, instructed to pickup on pharmacy and bring to clinic for administration|No HCG test required|HCG negative|HCG ordered and f/u results prior to injection being administered"]
[/conditional][conditional field="depoinj7" condition="(depoinj7).is('Progestin IM injection ordered and to be administered in clinic')"] -Date estimated/anticipated given: [date name="DepoDate7" default="today"]
-Next window: [calc memo="calc value" value="score1=(DepoDate7).dateAdd(77)"] THRU [calc memo="calc value" value="score1=(DepoDate7).dateAdd(105)"] [comment memo="11-15wk range backed by high quality evidence of efficacy" memo_size="small" memo_color="yellow"].
-If miss window for next injection, will need pregnancy test prior to injection.
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Copper IUD')&&(contra2).is('Progestin implant')"] -Goal of 4 days of overlap between old and new methods.
-Have implant inserted 4 days before copper IUD is removed or use backup contraception for 4 days after removal of copper IUD and insertion of implant.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Copper IUD')&&(contra2).is('Hormone IUD')"] -Have hormone IUD inserted right after copper IUD is removed and use back-up method for 7 days.
-Actions: [checkbox value="patient referred for procedure|procedure performed at same visit & see procedure note|patient appt scheduled for procedure"]
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Patch')&&(contra2).is('Patch')"]Not applicable - please select two different methods.
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Ring')&&(contra2).is('Ring')"]Not applicable - please select two different methods.
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Progestin shot')&&(contra2).is('Progestin shot')"]Not applicable - please select two different methods.
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Progestin implant')&&(contra2).is('Progestin implant')"]Not applicable - please select two different methods.
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Hormone IUD')&&(contra2).is('Hormone IUD')"]Not applicable - please select two different methods.
[/conditional][conditional field="contra1|contra2" condition="(contra1).is('Copper IUD')&&(contra2).is('Copper IUD')"]Not applicable - please select two different methods.
[/conditional][conditional field="contra1|contra2" condition="((contra1).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')&&(contra2).is('choose below'))||(contra2).is('abstinence/condoms/spermicide/withdrawal/fertility awareness/lactation/EC method')"] -Additional guidance:
[checkbox value=" -Using external condoms - use a new condom with each intercourse, pull out before penis gets soft wile holding onto the condom's ring, use a polyurethane condom is allergic to latex, 82% effective with proper use
"][checkbox value=" -Using internal condoms - use a new condom with each intercourse, use extra lubrication as needed, 79% effective with proper use
"][checkbox value=" -Using spermicide - insert more spermicide each intercourse, insert spermicide deep into vagina shortly before intercourse, 72% effective with proper use, may use condoms as well (to protect against HIV/STIs, increase effectiveness)
"][checkbox value=" -Using withdrawal/coitus interruptus method - pull penis out of vagina BEFORE ejaculation, does not work if penis not pulled out in time, 78% effective with proper use
"][checkbox value=" -Using fertility awareness/calendar method - predict fertile days by (1) taking temperature daily, (2) checking vaginal mucus for changes, AND/OR (3) keeping a record of menses; works best if using more than one of these methods; avoid intercourse or use condoms/spermicide during fertile days, 76% effective with proper use
"][checkbox value=" -Using breastfeeding/lactation amenorrhea method - nurse at least every 4 hours during the day and at least every 6 hours at night, must breastfeed exclusively (not bottles/formula/food), no long considered effective once first menses starts or 6 months after childbirth whichever comes first; 95% effective with proper use
"][checkbox value=" -If using emergency contraception pill method - works best the sooner it is taken after unprotected intercourse, can take pill no more than 5 days after unprotected intercourse, if pack contains 2 pills then take both pills together, can get some brands without prescription, 58-94% effective with proper use
"][/conditional][conditional field="wellvisitAPage|wellvisitAPgender" condition="((wellvisitAPage).isGreaterOrEqual('40')&&(wellvisitAPage).isLessOrEqual('79'))&&((wellvisitAPgender).is('F'))"][checkbox memo="F 50-79yo or higher risk based on shared decision making" 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')"][link url="https://bcrisktool.cancer.gov/calculator.html" memo="assessment tool website
"] - 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('18')"][checkbox memo="M/F ages 18-79" 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('50')&&(wellvisitAPage).isLessOrEqual('80'))&&((wellvisitAPtobacco).is('current')||(wellvisitAPtobacco).is('former'))"][checkbox memo="M/F 50-80yo, 20 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('20')&&(wellvisitAPage).isLessOrEqual('80')"][checkbox memo="M/F 45-75yo or high risk" 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-DNA (q3yrs)|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="≥18yo" memo_size="small" name="VAC1" value=" -Influenza Vaccine, annually"][conditional field="VAC1" condition="(VAC1).is(' -Influenza Vaccine, annually')"] - [comment memo=" 18-64yo options: (IIV=inactivated; RIV=recombinant; LAIV=live-attenuated)
(1) Flucelvax Quadrivalent (IIV, cell-based, egg-free)
(2) Flublok Quadrivalent (RIV, egg-free, high-dose/3x)
(3) Afluria, Fluarix, FluLaval, Fluzone Std-Dose (IIV, egg-based)
(3) Fluzone High-Dose Quadrivalent (IIV, egg-based, high-dose/4x)
(4) Fluad Quadrivalent (IIV with adjuvant, egg-based, high-dose equiv)
(5) FluMist Quadrivalent for 18-49yo (LAIV, not for pregnant/immunocompromised/other medical conditions)
≥65yo options:
(1) Flublok Quadrivalent (RIV, egg-free, high-dose/3x)
(2) Fluzone High-Dose Quadrivalent (IIV, egg-based, high-dose/4x)
(3) Fluad Quadrivalent (IIV with adjuvant, egg-based, high-dose equiv)" memo_size="small" memo_color="yellow"][checkbox value="patient uptodate|patient agreed, prefers to schedule separately from visit|patient agreed, not available at our clinic, advised of available off-site options where to receive vaccination|patient to receive at todays visit|patient declined & will continue to address each visit"]
[/conditional][checkbox memo="≥18yo" memo_size="small" name="VAC12" value=" -COVID Vaccine"][conditional field="VAC12" condition="(VAC12).is(' -COVID Vaccine')"] - [comment memo="(1) Pfizer-BioNTech mRNA 2-dose primary series 3-8wks apart (12-39yoM may consider waiting full 8 weeks between 1st/2nd dose to minimize rare risk of myocarditis/pericarditis), updated booster (Pfizer or Moderna) ≥2mo after 2nd dose or last booster
(2) Moderna mRNA 2-dose primary series 4-8wks apart  (12-39yoM may consider waiting full 8 weeks between 1st/2nd dose to minimize rare risk of myocarditis/pericarditis), updated booster (Pfizer or Moderna) ≥2mo after 2nd dose or last booster
(3) Novovax 2-dose primary series 3-8wks apart, updated booster (Pfizer or Moderna) ≥2mo after 2nd dose or last booster
(4) J&J Jannsen 1-dose, updated booster (Pfizer or Moderna) ≥2mo after 2nd dose or last booster" memo_size="small" memo_color="yellow"][checkbox value="patient uptodate (primary series and booster)|vaccination series in progress, discussed scheduling of next dose|patient agreed, prefers to schedule separately from visit|patient agreed, not available at our clinic, advised of available off-site options where to receive vaccination|patient to receive at todays visit|patient declined & will continue to address each 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 agreed, prefers to schedule separately from 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 agreed, prefers to schedule separately from 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:
-diabetes
-alcoholism
-current cigarette smoking
-congenital or acquired immunodeficiencies (ie. B/T lymphocyte deficiency, complement deficiencies, phagocytic disorders, HIV infection)
-CSF leak or cochlear implants
-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="PCV15 1 dose + PPSV23 1 dose (1yr later)|PCV20 1 dose"] [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][checkbox memo="Newly identified issues" memo_color="powderblue" memo_style="bold" name="addlissues" value=""][conditional field="addlissues" condition="(addlissues).is('')"][comment memo="(if used, use separate E&M code with Prev Med code with 25 modifier)" memo_size="small" memo_color="lightyellow"]

Issues discovered/addressed: 
[textarea default="#" rows="5"][/conditional][checkbox memo="Dispo / Followup" memo_color="lightgray" memo_style="bold" name="dispo" value=""][conditional field="dispo" condition="(dispo).is('')"]

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"][/conditional][checkbox memo="Attestations for coding" memo_color="whitesmoke" memo_style="bold" name="codingblurbs" value=""][conditional field="codingblurbs" condition="(codingblurbs).is('')"]

[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][conditional field="APvirtualblurb" condition="(APvirtualblurb).is('Virtual Encounter Verbage')"]
[/conditional][checkbox name="APvirtualblurb" memo="*" memo_color="blue" memo_size="small" value="Virtual Encounter Verbage"]
[conditional field="APvirtualblurb" condition="(APvirtualblurb).is('Virtual Encounter Verbage')"] - 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]
A/P:
#WELL ADULT VISIT for age yo gender
-tobacco status
-BMI status
-high-risk sexual behavior >1 sexual parner in last year, hx of STIs, receptive anal intercourse ASCVD risk
-Spent minutes discussing the following preventative health topics and screenings:

USPSTF Guidelines (A/B Recommendations)
M/F overweight/obese or other CV risks
-Discussed the following vaccinations based on CDC recommendations:
CDC Adult Immunization Schedule ≥18yo ≥18yo ≥19yo, either Tdap or Td acceptable, ensure ≥1 Tdap ≥65yo or 19-64yo with specific conditions ≥19yo if desires or at risk ≥19yo if desires or at risk ≥19yo with certain conditions ≥19yo with certain conditions Newly identified issues Dispo / Followup Attestations for coding *

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.96, 357 form elements, 32 boilerplate words, 6 text boxes, 2 text areas, 7 dates, 162 checkboxes, 11 drop downs, 1 links, 17 comments, 14 calculations, 137 conditionals, 454 total clicks
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