Procedure Note
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[comment memo="1st Trimester Ultrasound Procedure Note"]
LIMITED FIRST TRIMESTER ULTRASOUND (FOR DATING PURPOSES)
Number of Fetuses: [select value="singleton|"][text size="20"]
Cardiac Activity: [select name="FHR" value="FHR|present but indeterminant by M-mode|not present"][conditional field="FHR" condition="(FHR).is('FHR')"] [text size="4"] bpm, calculated via M-mode.[/conditional]
Assessments: [checkbox name="Measure" value="yolk sac present|fetal/embryonic pole present|crown-rump length assessed|mean sac diameter assessed"].
[conditional field="Measure" condition="(Measure).is('crown-rump length assessed')"]

CRL Measurements:
CRL: [text size="8"] cm; Gestational Age: [text size="3"]w[text size="3"]d
CRL: [text size="8"] cm; Gestational Age: [text size="3"]w[text size="3"]d
CRL: [text size="8"] cm; Gestational Age: [text size="3"]w[text size="3"]d[/conditional][conditional field="Measure" condition="(Measure).is('mean sac diameter assessed')"]

Gestation Sac Measurements:
Sac Measurement#1: [text size="8"] cm
Sac Measurement#2: [text size="8"] cm
Sac Measurement#3: [text size="8"] cm
Mean Sac Diameter: [text size="8"] cm[/conditional]

Interpretation:
[select name="Interpretation" value="Intrauterine Pregnancy|Viability of pregnancy indeterminant|Possible embryonic demise"][conditional field="Interpretation" condition="(Interpretation).is('Intrauterine Pregnancy')"] with mean CRL of [text size="8"] cm; Gestational Age: [text size="3"]w[text size="3"]d [comment memo="mean of 3 CRL measurements"]
EDC is [text default="DD MMM YYYY" size="12"] based on [select value="LMP c/b 1st tri U/S|1st tri U/S"][/conditional][conditional field="Interpretation" condition="(Interpretation).isNot('Intrauterine Pregnancy')"].
[textarea][/conditional]

Discussed with patient the limitations of this ultrasound, inability to completely rule out ectopic/heterotopic pregnancies, inability to rule out pelvic gynecologic pathologies, inability to rule out genetic abnormalities, and inability to rule out congenital malformations/deformities.

Followup plan: [text size="80"]
1st Trimester Ultrasound Procedure Note
LIMITED FIRST TRIMESTER ULTRASOUND (FOR DATING PURPOSES)
Number of Fetuses:
Cardiac Activity:
Assessments: .


Interpretation:


Discussed with patient the limitations of this ultrasound, inability to completely rule out ectopic/heterotopic pregnancies, inability to rule out pelvic gynecologic pathologies, inability to rule out genetic abnormalities, and inability to rule out congenital malformations/deformities.

Followup plan:
Result - Copy and paste this output: