[checkbox value="-Suspect common cold based on history and physical exam.
"][checkbox value="-No focal bacterial infection identified.
"][checkbox value="-Advised pt that sx duration usually 7-10 days (3 days longer in smokers).
"][checkbox value="-Reassured patient that abx not currently indicated and have side effects.
"][checkbox value="-Advised pt of the risks/benefits of sx mgmt.
"][checkbox value="-Pt declined symptomatic treatment.
"][checkbox name="URTItx" value="-The patient requests the following symptomatic tx which were ordered:"][conditional field="URTItx" condition="(URTItx).is('-The patient requests the following symptomatic tx which were ordered:')"] [checkbox value="acetaminophen (Discussed appropriate dosing, alcohol avoidance, and hepatotoxicity risk)|NSAIDs (Discussed appropriate dosing, limiting use to 1-2 weeks, and potential risks including: GI bleed, renal failure, CV events)|oral antihistamine (discussed prn use, side effects risk of drowsiness, constipation, mental confusion, falls if elderly)|Nasal saline|Decongestants (Discussed limiting use to less than 72 hours; discussed risks of tachycardia/arrhythmias, anxiety, insomnia, hypertension, and rebound rhinitis|Brown Honey (OTC only, not for use in chilren under 1 year old)|Vapor Rub (OTC only)|Benzonatate capsules (cough suppressant, swallow whole)|Menthol lozenges|Zinc lozenges (may shorten duration of illness, OTC only)|Guaifenesin (Discussed possible drowsiness, headache, rash, nausea, and limited trials of efficacy)|Nasal steroids (Discussed possible nasal dryness, thrush, epistaxis)"].
[/conditional]-Gave return precautions to include: [checkbox value="fever over 101F not relieved by tylenol/NSAIDS|purulent discharge|severe facial pain|shortness of breath|difficulty swallowing|sx >10 days|sx worsen after previously improving"].
[checkbox value="-The patient indicated understanding and intent to comply.
There are 12 form elements.
Result - Copy and paste this output: