Procedure Note
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12-LEAD EKG REPORT & INTERPRETATION

Indication: [text size="80"]

Findings:
-Rate: [text size="5"] bpm [checkbox value="- normal"]
-Predominant Rhythm: [checkbox name="rhythm" value="sinus rhythm"] [conditional field="rhythm" condition="(rhythm).isNot('sinus rhythm')"][checkbox value="sinus bradycardia|sinus tachycardia|atrial fibrillation|pacemaker rhythm|other"]. [text memo="explanation" memo_size="small" size="80"][/conditional]
-Axis: [checkbox name="axis" value="normal"][conditional field="axis" condition="(axis).isNot('normal')"][checkbox value="L Axis Deviation|R Axis Deviation|Indeterminate"]. [text memo="explanation" memo_size="small" size="80"][/conditional]
-Blocks: [checkbox name="blocks" value="none"][conditional field="blocks" condition="(blocks).isNot('none')"][checkbox value="1st degree AV block|2nd degree mobitz type 1 AV block|2nd degree mobitz type 2 AV block|3rd degree/complete AV block|R Complete BBB|R Incomplete BBB|L Complete BBB|L Incomplete BBB|L Anterior Hemiblock|L Posterior Hemiblock"][/conditional]
-P Wave morphology: [checkbox name="pwave" value="normal/uniform"][conditional field="pwave" condition="(pwave).isNot('normal/uniform')"][text memo="explanation" memo_size="small" size="80"][/conditional]
-QRS complex: [checkbox name="qrs" value="normal width/morphology"][conditional field="qrs" condition="(qrs).isNot('normal width/morphology')"][text memo="explanation" memo_size="small" size="80"][/conditional]
-R wave progression: [checkbox name="rwave" value="normal|POOR"]
-T wave morphology- [checkbox name="twave" value="normal"][conditional field="twave" condition="(twave).isNot('normal')"][checkbox value="flattened.|inverted.|peaked."] [text memo="explanation" memo_size="small" default="affected leads-" size="80"][/conditional]
-QTc interval- [checkbox name="qtc" value="normal"][conditional field="qtc" condition="(qtc).isNot('normal')"][checkbox value="borderline|prolonged"][/conditional]
-PR segment(s)- [checkbox name="prseg" value="normal"][conditional field="prseg" condition="(prseg).isNot('normal')"][checkbox value="elevated.|depressed."] [text memo="explanation" memo_size="small" default="affected leads-" size="80"][/conditional]
-ST segment(s)- [checkbox name="stseg" value="normal"][conditional field="stseg" condition="(stseg).isNot('normal')"][checkbox value="elevated.|depressed."] [text memo="explanation" memo_size="small" default="affected leads-" size="80"][/conditional]

Comparison: [checkbox name="comparison" value="no interval change|no prior EKG to compare"][conditional field="comparison" condition="(comparison).isNot('no interval change')&&(comparison).isNot('no prior EKG to compare')"] [text memo="explanation" memo_size="small" size="80"][/conditional]

Interpretation/Conclusion: [checkbox name="interpretation" value="normal EKG."] [textarea memo="explanation if needed" memo_size="small"]
12-LEAD EKG REPORT & INTERPRETATION

Indication:

Findings:
-Rate: bpm
-Predominant Rhythm:
-Axis:
-Blocks:
-P Wave morphology:
-QRS complex:
-R wave progression:
-T wave morphology-
-QTc interval-
-PR segment(s)-
-ST segment(s)-

Comparison:

Interpretation/Conclusion: explanation if needed
Result - Copy and paste this output: